1
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Asmussen L, Frey BM, Frontzkowski LK, Wróbel PP, Grigutsch LS, Choe CU, Bönstrup M, Cheng B, Thomalla G, Quandt F, Gerloff C, Schulz R. Dopaminergic mesolimbic structural reserve is positively linked to better outcome after severe stroke. Brain Commun 2024; 6:fcae122. [PMID: 38712322 PMCID: PMC11073754 DOI: 10.1093/braincomms/fcae122] [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: 08/13/2023] [Revised: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
The concept of brain reserve capacity has emerged in stroke recovery research in recent years. Imaging-based biomarkers of brain health have helped to better understand outcome variability in clinical cohorts. Still, outcome inferences are far from being satisfactory, particularly in patients with severe initial deficits. Neurorehabilitation after stroke is a complex process, comprising adaption and learning processes, which, on their part, are critically influenced by motivational and reward-related cognitive processes. Amongst others, dopaminergic neurotransmission is a key contributor to these mechanisms. The question arises, whether the amount of structural reserve capacity in the dopaminergic system might inform about outcome variability after severe stroke. For this purpose, this study analysed imaging and clinical data of 42 severely impaired acute stroke patients. Brain volumetry was performed within the first 2 weeks after the event using the Computational Anatomy Toolbox CAT12, grey matter volume estimates were collected for seven key areas of the human dopaminergic system along the mesocortical, mesolimbic and nigrostriatal pathways. Ordinal logistic regression models related regional volumes to the functional outcome, operationalized by the modified Rankin Scale, obtained 3-6 months after stroke. Models were adjusted for age, lesion volume and initial impairment. The main finding was that larger volumes of the amygdala and the nucleus accumbens at baseline were positively associated with a more favourable outcome. These data suggest a link between the structural state of mesolimbic key areas contributing to motor learning, motivational and reward-related brain networks and potentially the success of neurorehabilitation. They might also provide novel evidence to reconsider dopaminergic interventions particularly in severely impaired stroke patients to enhance recovery after stroke.
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Affiliation(s)
- Liv Asmussen
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Benedikt M Frey
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Lukas K Frontzkowski
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Paweł P Wróbel
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - L Sophie Grigutsch
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Chi-un Choe
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Marlene Bönstrup
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
- University Medical Center Leipzig, Department of Neurology, 04103 Leipzig, Germany
| | - Bastian Cheng
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Götz Thomalla
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Fanny Quandt
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Christian Gerloff
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
| | - Robert Schulz
- University Medical Center Hamburg-Eppendorf, Department of Neurology, 20246 Hamburg, Germany
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2
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Lisco G, De Tullio A, Iovino M, Disoteo O, Guastamacchia E, Giagulli VA, Triggiani V. Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes. Biomedicines 2023; 11:2993. [PMID: 38001993 PMCID: PMC10669051 DOI: 10.3390/biomedicines11112993] [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: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Dopamine regulates several functions, such as voluntary movements, spatial memory, motivation, sleep, arousal, feeding, immune function, maternal behaviors, and lactation. Less clear is the role of dopamine in the pathophysiology of type 2 diabetes mellitus (T2D) and chronic complications and conditions frequently associated with it. This review summarizes recent evidence on the role of dopamine in regulating insular metabolism and activity, the pathophysiology of traditional chronic complications associated with T2D, the pathophysiological interconnection between T2D and chronic neurological and psychiatric disorders characterized by impaired dopamine activity/metabolism, and therapeutic implications. Reinforcing dopamine signaling is therapeutic in T2D, especially in patients with dopamine-related disorders, such as Parkinson's and Huntington's diseases, addictions, and attention-deficit/hyperactivity disorder. On the other hand, although specific trials are probably needed, certain medications approved for T2D (e.g., metformin, pioglitazone, incretin-based therapy, and gliflozins) may have a therapeutic role in such dopamine-related disorders due to anti-inflammatory and anti-oxidative effects, improvement in insulin signaling, neuroinflammation, mitochondrial dysfunction, autophagy, and apoptosis, restoration of striatal dopamine synthesis, and modulation of dopamine signaling associated with reward and hedonic eating. Last, targeting dopamine metabolism could have the potential for diagnostic and therapeutic purposes in chronic diabetes-related complications, such as diabetic retinopathy.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy; (G.L.); (A.D.T.); (M.I.); (E.G.); (V.A.G.)
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy; (G.L.); (A.D.T.); (M.I.); (E.G.); (V.A.G.)
| | - Michele Iovino
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy; (G.L.); (A.D.T.); (M.I.); (E.G.); (V.A.G.)
| | - Olga Disoteo
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy; (G.L.); (A.D.T.); (M.I.); (E.G.); (V.A.G.)
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy; (G.L.); (A.D.T.); (M.I.); (E.G.); (V.A.G.)
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy; (G.L.); (A.D.T.); (M.I.); (E.G.); (V.A.G.)
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3
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Li S. Stroke Recovery Is a Journey: Prediction and Potentials of Motor Recovery after a Stroke from a Practical Perspective. Life (Basel) 2023; 13:2061. [PMID: 37895442 PMCID: PMC10608684 DOI: 10.3390/life13102061] [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: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to chronic stages and to maintain their function in the chronic stages. Health conditions of individuals, medical and neurological complications can be optimized under the care of specialized physicians. This permits stroke survivors to participate in various therapeutic interventions. Sufficient doses of appropriate interventions at the right time is critical for stroke motor rehabilitation. It is important to highlight that combining interventions is likely to yield better clinical outcomes. Caregivers, including family members, can assist and facilitate targeted therapeutic exercises for these individuals and can help stroke survivors comply with medical plans (medications, visits), and provide emotional support. With health optimization, comprehensive rehabilitation, support from family and caregivers and a commitment to a healthy lifestyle, many stroke survivors can overcome barriers and achieve potentials of maximum recovery and maintain their motor function in chronic stages. This ICF recovery model is likely to provide a guidance through the journey to best achieve stroke recovery potentials.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center—Houston, Houston, TX 77025, USA;
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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4
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Tian Z, Lu XT, Jiang X, Tian J. Bryostatin-1: a promising compound for neurological disorders. Front Pharmacol 2023; 14:1187411. [PMID: 37351510 PMCID: PMC10282138 DOI: 10.3389/fphar.2023.1187411] [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: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
The central nervous system (CNS) is the most complex system in human body, and there is often a lack of effective treatment strategies for the disorders related with CNS. Natural compounds with multiple pharmacological activities may offer better options because they have broad cellular targets and potentially produce synergic and integrative effects. Bryostatin-1 is one of such promising compounds, a macrolide separated from marine invertebrates. Bryostatin-1 has been shown to produce various biological activities through binding with protein kinase C (PKC). In this review, we mainly summarize the pharmacological effects of bryostatin-1 in the treatment of multiple neurological diseases in preclinical studies and clinical trials. Bryostatin-1 is shown to have great therapeutic potential for Alzheimer's disease, multiple sclerosis, fragile X syndrome, stroke, traumatic brain injury, and depression. It exhibits significant rescuing effects on the deficits of spatial learning, cognitive function, memory and other neurological functions caused by diseases, producing good neuroprotective effects. The promising neuropharmacological activities of bryostatin-1 suggest that it is a potential candidate for the treatment of related neurological disorders although there are still some issues needed to be addressed before its application in clinic.
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Affiliation(s)
- Zhen Tian
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Xin-Tong Lu
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Xun Jiang
- Department of Pediatrics, Tangdu Hospital of Fourth Military Medical University, Xi’an, China
| | - Jiao Tian
- Department of Infection, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, The First Batch of Key Disciplines on Public Health in Chongqing, Chongqing, China
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5
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Effects of exercise and bryostatin-1 on functional recovery and posttranslational modification in the perilesional cortex after cerebral infarction. Neuroreport 2023; 34:267-272. [PMID: 36881749 DOI: 10.1097/wnr.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Strokes can cause a variety of sequelae, such as paralysis, particularly in the early stages after stroke onset. Rehabilitation therapy atthis time often provides some degree of paralysis recovery. Neuroplasticity in the peri-infarcted cerebral cortex induced by exercise training may contribute to recovery of paralysis after cerebral infarction. However, the molecular mechanism of this process remains unclear. This study focused on brain protein kinase C (PKC), which is speculated to be involved in neuroplasticity. We evaluated the functional recovery of cerebral infarction model rats, by using rotarod test after running wheel training and with/without administration of bryostatin, a PKC activator. In addition, the expression of phosphorylated and unphosphorylated PKC subtypes, glycogen synthase kinase 3β (GSK3β), and collapsin response-mediator proteins 2 (CRMP2) were analyzed by Western blotting. In the rotarod test, bryostatin administration alone had no effect on gait duration, but the combination of training and this drug significantly prolonged gait duration compared with training alone. In protein expression analysis, the combination of training and bryostatin significantly increased phosphorylation of PKCα and PKCε isoforms, increased phosphorylation of GSK3β, which acts downstream of PKC, and decreased phosphorylation of CRMP2. The effect of bryostatin in combination with training appears to be mediated via PKC phosphorylation, with effects on functional recovery occurring through the downstream regulation of GSK3β and CRMP2 phosphorylation.
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6
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Badawi AS, Mogharbel GH, Aljohani SA, Surrati AM. Predictive Factors and Interventional Modalities of Post-stroke Motor Recovery: An Overview. Cureus 2023; 15:e35971. [PMID: 37041905 PMCID: PMC10082951 DOI: 10.7759/cureus.35971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Stroke is the most common cause of motor impairment worldwide. Therefore, many factors are being investigated for their predictive and facilitatory effects on recovery of motor function after stroke. Motor recovery can be predicted through several factors, such as clinical assessment, clinical biomarkers, and gene-based variations. As for interventions, many methods are under experimental investigation that aim to improve motor recovery, including different types of pharmacological interventions, non-invasive stimulation, and rehabilitation training by inducing cortical reorganization, neuroplasticity, angiogenesis, changing the levels of neurotransmitters in the brain, and altering the inflammatory and apoptotic processes occurring after stroke. Studies have shown that clinical biomarkers combined with clinical assessment and gene-based variations are reliable factors for predicting motor recovery after stroke. Moreover, different types of interventions such as pharmacological agents (selective serotonin reuptake inhibitors {SSRI}, noradrenaline reuptake inhibitors {NARIs}, levodopa, and amphetamine), non-invasive stimulation, and rehabilitation training have shown significant results in improving functional and motor recovery.
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7
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Cramer SC, Lin DJ, Finklestein SP. Domain-Specific Outcome Measures in Clinical Trials of Therapies Promoting Stroke Recovery: A Suggested Blueprint. Stroke 2023; 54:e86-e90. [PMID: 36848418 PMCID: PMC9991075 DOI: 10.1161/strokeaha.122.042313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/11/2023] [Indexed: 03/01/2023]
Abstract
Different deficits recover to different degrees and with different time courses after stroke, indicating that plasticity differs across the brain's neural systems after stroke. To capture these differences, domain-specific outcome measures have received increased attention. Such measures have potential advantages over global outcome scales, which combine recovery across many domains into a single score and so blur the ability to capture individual measures of stroke recovery. Use of a global end point to rate disability can overlook substantial recovery in specific domains, such as motor or language, and may not differentiate between good and poor recovery for specific neurological domains. In light of these points, a blueprint is proposed for using domain-specific outcome measures in stroke recovery trials. Key steps include selecting a domain in the context of preclinical data, picking a domain-specific clinical trial end point, anchoring inclusion criteria to this end point, scoring this end point both before and after treatment, and then pursuing regulatory approval on the basis of the domain-specific results. This blueprint is intended to foster clinical trials that, by using domain-specific end points, are able to demonstrate favorable results in clinical trials of therapies that promote stroke recovery.
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Affiliation(s)
- Steven C. Cramer
- Dept. Neurology, University of California, Los Angeles; and California Rehabilitation Institute; Los Angeles, CA
| | - David J Lin
- Stroke Service and Dept. Neurology; Massachusetts General Hospital, Harvard Medical School; Boston, MA
- Center for Neurotechnology and Neurorecovery and Division of Neurocritical Care; Massachusetts General Hospital, Harvard Medical School; Boston, MA
- Center for Neurorestoration and Neurotechnology; Rehabilitation Research and Development Service; Department of Veterans Affairs; Providence, RI
| | - Seth P Finklestein
- Stroke Service and Dept. Neurology; Massachusetts General Hospital, Harvard Medical School; Boston, MA
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8
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Hosp JA, Dressing A, Engesser A, Glauche V, Kümmerer D, Vaidelyte EB, Musso M, Rijntjes M, Weiller C. The Role of Ascending Ventral-Tegmental Fibers for Recovery after Stroke. Ann Neurol 2022; 93:922-933. [PMID: 36585896 DOI: 10.1002/ana.26595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The integrity of cortical motor networks and their descending effector pathway (the corticospinal tract [CST]) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to the motor cortex (the VTMC tract) for post-stroke recovery. METHODS Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC tract and CST were obtained from 133 patients (63.9 ± 13.4 years, 45 women) during the acute and chronic stage after the first ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale with motor and cortical symptom subscores; modified Fugl-Meyer upper extremity score; modified Ranking Scale [mRS]). RESULTS A significant post-stroke degeneration occurred in both tracts, but only VTMC degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (modified Fugl-Meyer upper extremity score) and cortical symptoms (aphasia, neglect) captured by National Institute of Health Stroke Scale compared to CST. Changes in CST integrity merely were associated with the degree of hemiparesis (National Institute of Health Stroke Scale motor subscale). INTERPRETATION Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favorable outcome regarding independence (modified Ranking Scale), upper limb motor function (modified Fugl-Meyer upper extremity score), and cortical symptoms (aphasia, neglect) was more strongly related to the ascending than descending tract. ANN NEUROL 2023.
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Affiliation(s)
- Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anika Engesser
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kümmerer
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ema B Vaidelyte
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mariachristina Musso
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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9
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Huang S, Liu L, Tang X, Xie S, Li X, Kang X, Zhu S. Research progress on the role of hormones in ischemic stroke. Front Immunol 2022; 13:1062977. [PMID: 36569944 PMCID: PMC9769407 DOI: 10.3389/fimmu.2022.1062977] [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: 10/06/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Ischemic stroke is a major cause of death and disability around the world. However, ischemic stroke treatment is currently limited, with a narrow therapeutic window and unsatisfactory post-treatment outcomes. Therefore, it is critical to investigate the pathophysiological mechanisms following ischemic stroke brain injury. Changes in the immunometabolism and endocrine system after ischemic stroke are important in understanding the pathophysiological mechanisms of cerebral ischemic injury. Hormones are biologically active substances produced by endocrine glands or endocrine cells that play an important role in the organism's growth, development, metabolism, reproduction, and aging. Hormone research in ischemic stroke has made very promising progress. Hormone levels fluctuate during an ischemic stroke. Hormones regulate neuronal plasticity, promote neurotrophic factor formation, reduce cell death, apoptosis, inflammation, excitotoxicity, oxidative and nitrative stress, and brain edema in ischemic stroke. In recent years, many studies have been done on the role of thyroid hormone, growth hormone, testosterone, prolactin, oxytocin, glucocorticoid, parathyroid hormone, and dopamine in ischemic stroke, but comprehensive reviews are scarce. This review focuses on the role of hormones in the pathophysiology of ischemic stroke and discusses the mechanisms involved, intending to provide a reference value for ischemic stroke treatment and prevention.
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Affiliation(s)
- Shuyuan Huang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lu Liu
- Department of Anesthesiology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xiaodong Tang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shulan Xie
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinrui Li
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xianhui Kang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Xianhui Kang, ; Shengmei Zhu,
| | - Shengmei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Xianhui Kang, ; Shengmei Zhu,
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10
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Grau-Sánchez J, Jamey K, Paraskevopoulos E, Dalla Bella S, Gold C, Schlaug G, Belleville S, Rodríguez-Fornells A, Hackney ME, Särkämö T. Putting music to trial: Consensus on key methodological challenges investigating music-based rehabilitation. Ann N Y Acad Sci 2022; 1518:12-24. [PMID: 36177875 PMCID: PMC10091788 DOI: 10.1111/nyas.14892] [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] [Indexed: 02/05/2023]
Abstract
Major advances in music neuroscience have fueled a growing interest in music-based neurological rehabilitation among researchers and clinicians. Musical activities are excellently suited to be adapted for clinical practice because of their multisensory nature, their demands on cognitive, language, and motor functions, and music's ability to induce emotions and regulate mood. However, the overall quality of music-based rehabilitation research remains low to moderate for most populations and outcomes. In this consensus article, expert panelists who participated in the Neuroscience and Music VII conference in June 2021 address methodological challenges relevant to music-based rehabilitation research. The article aims to provide guidance on challenges related to treatment, outcomes, research designs, and implementation in music-based rehabilitation research. The article addresses how to define music-based rehabilitation, select appropriate control interventions and outcomes, incorporate technology, and consider individual differences, among other challenges. The article highlights the value of the framework for the development and evaluation of complex interventions for music-based rehabilitation research and the need for stronger methodological rigor to allow the widespread implementation of music-based rehabilitation into regular clinical practice.
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Affiliation(s)
- Jennifer Grau-Sánchez
- School of Nursing and Occupational Therapy of Terrassa, Autonomous University of Barcelona, Terrassa, Spain.,Cognition and Brain Plasticity Unit, Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Kevin Jamey
- International Laboratory for Brain, Music and Sounds Research (BRAMS), Montreal, Québec, Canada.,Department of Psychology, University of Montreal, Montreal, Québec, Canada.,Centre for Research on Brain, Language and Music (CRBLM), Montreal, Québec, Canada
| | | | - Simone Dalla Bella
- International Laboratory for Brain, Music and Sounds Research (BRAMS), Montreal, Québec, Canada.,Department of Psychology, University of Montreal, Montreal, Québec, Canada.,Centre for Research on Brain, Language and Music (CRBLM), Montreal, Québec, Canada
| | - Christian Gold
- NORCE Norwegian Research Centre AS, Bergen, Norway.,Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Gottfried Schlaug
- Music, Neuroimaging, and Stroke Recovery Laboratories, Department of Neurology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.,Department of Biomedical Engineering/Institute of Applied Life Sciences at UMass Amherst, Amherst, Massachusetts, USA
| | - Sylvie Belleville
- Department of Psychology, University of Montreal, Montreal, Québec, Canada.,Centre de recherche de l'Institut Universitaire de gériatrie de Montréal, Montreal, Québec, Canada
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Unit, Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Madeleine E Hackney
- Departments of Medicine and Rehabilitation Medicine, Emory University School of Medicine, Emory University School of Nursing, Atlanta, Georgia, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, USA.,Birmingham/Atlanta VA Geriatric Rehabilitation Education and Clinical Center, Decatur, Georgia, USA
| | - Teppo Särkämö
- Cognitive Brain Research Unit (CBRU), Department of Psychology and Logopedics, Faculty of Medicine and Centre of Excellence in Music, Mind, Body and Brain (MMBB), University of Helsinki, Helsinki, Finland
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11
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Coliță D, Coliță CI, Hermann DM, Coliță E, Doeppner TR, Udristoiu I, Popa-Wagner A. Therapeutic Use and Chronic Abuse of CNS Stimulants and Anabolic Drugs. Curr Issues Mol Biol 2022; 44:4902-4920. [PMID: 36286048 PMCID: PMC9600088 DOI: 10.3390/cimb44100333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
The available evidence suggests that affective disorders, such as depression and anxiety, increase risk for accelerated cognitive decline and late-life dementia in aging individuals. Behavioral neuropsychology studies also showed that cognitive decline is a central feature of aging impacting the quality of life. Motor deficits are common after traumatic brain injuries and stroke, affect subjective well-being, and are linked with reduced quality of life. Currently, restorative therapies that target the brain directly to restore cognitive and motor tasks in aging and disease are available. However, the very same drugs used for therapeutic purposes are employed by athletes as stimulants either to increase performance for fame and financial rewards or as recreational drugs. Unfortunately, most of these drugs have severe side effects and pose a serious threat to the health of athletes. The use of performance-enhancing drugs by children and teenagers has increased tremendously due to the decrease in the age of players in competitive sports and the availability of various stimulants in many forms and shapes. Thus, doping may cause serious health-threatening conditions including, infertility, subdural hematomas, liver and kidney dysfunction, peripheral edema, cardiac hypertrophy, myocardial ischemia, thrombosis, and cardiovascular disease. In this review, we focus on the impact of doping on psychopathological disorders, cognition, and depression. Occasionally, we also refer to chronic use of therapeutic drugs to increase physical performance and highlight the underlying mechanisms. We conclude that raising awareness on the health risks of doping in sport for all shall promote an increased awareness for healthy lifestyles across all generations.
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Affiliation(s)
- Daniela Coliță
- Doctoral School, University of Medicine and Pharmacy “Carol Davila”, 020276 Bucharest, Romania
| | - Cezar-Ivan Coliță
- Doctoral School, University of Medicine and Pharmacy “Carol Davila”, 020276 Bucharest, Romania
- Correspondence: (C.-I.C.); (I.U.); (A.P.-W.)
| | - Dirk M. Hermann
- Chair of Vascular Neurology, Dementia and Ageing, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Eugen Coliță
- Doctoral School, University of Medicine and Pharmacy “Carol Davila”, 020276 Bucharest, Romania
| | - Thorsten R. Doeppner
- Department of Neurology, University Medical Center Göttingen, 37075 Gottingen, Germany
- Department of Neurology, University Hospital Giessen, 35394 Giessen, Germany
| | - Ion Udristoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (C.-I.C.); (I.U.); (A.P.-W.)
| | - Aurel Popa-Wagner
- Chair of Vascular Neurology, Dementia and Ageing, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (C.-I.C.); (I.U.); (A.P.-W.)
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12
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GÜLER Ö, TUĞAN YILDIZ B, HAKKOYMAZ H, AYDIN S, YARDIM M. Levels of Serum and Urine Catecholaminergic and Apelinergic System Members in Acute Ischemic Stroke Patients. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1168625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objective: To compare levels of catecholaminergic system members, renalase, cerebellin, and their substrates, epinephrine, norepinephrine, and dopamine, and apelinergic system members, apelin, elabela, and nitric oxide in the blood and urine of patients with acute ischemic stroke and healthy controls.
Materials and Methods: 42 patients with acute ischemic stroke and 42 age and sex-matched healthy controls were included in the study. Blood and urine samples were collected simultaneously and within the first 24 hours after the onset of acute stroke clinical manifestations and were measured using an ELISA method.
Results: The levels of serum and urine cerebellin, renalase, epinephrine, norepinephrine, dopamine, apelin, elebela, and nitric oxide were similar in ischemic stroke and in control groups (P>0.05). Strong correlations were found between renalase, cerebellin, and catecholamine levels in serum and urine (p
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13
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Ganguly K, Khanna P, Morecraft R, Lin DJ. Modulation of neural co-firing to enhance network transmission and improve motor function after stroke. Neuron 2022; 110:2363-2385. [PMID: 35926452 PMCID: PMC9366919 DOI: 10.1016/j.neuron.2022.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/15/2022] [Accepted: 06/28/2022] [Indexed: 01/28/2023]
Abstract
Stroke is a leading cause of disability. While neurotechnology has shown promise for improving upper limb recovery after stroke, efficacy in clinical trials has been variable. Our central thesis is that to improve clinical translation, we need to develop a common neurophysiological framework for understanding how neurotechnology alters network activity. Our perspective discusses principles for how motor networks, both healthy and those recovering from stroke, subserve reach-to-grasp movements. We focus on neural processing at the resolution of single movements, the timescale at which neurotechnologies are applied, and discuss how this activity might drive long-term plasticity. We propose that future studies should focus on cross-area communication and bridging our understanding of timescales ranging from single trials within a session to across multiple sessions. We hope that this perspective establishes a combined path forward for preclinical and clinical research with the goal of more robust clinical translation of neurotechnology.
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Affiliation(s)
- Karunesh Ganguly
- Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA,Neurology Service, SFVAHCS, San Francisco, CA, USA,
| | - Preeya Khanna
- Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA,Neurology Service, SFVAHCS, San Francisco, CA, USA
| | - Robert Morecraft
- Laboratory of Neurological Sciences, Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, SD, 57069 USA
| | - David J. Lin
- Center for Neurotechnology and Neurorecovery, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA,Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Providence VA Medical Center, Providence, RI
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14
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Moncayo JA, Yepez M, Camacho M, Aguirre AS, Ojeda D, Ortiz JF, Sen M, Argudo J, Proano L, Cordova S, Kothari N. Use of Levodopa After a Stroke: A Systematic Review. Cureus 2022; 14:e24529. [PMID: 35651458 PMCID: PMC9138904 DOI: 10.7759/cureus.24529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Stroke is a leading cause of death and disability, especially in certain ethnic groups. Impaired consciousness is a common outcome in stroke patients, serving as a predictor of prognosis and mortality. Lately, there has been increased interest in drugs such as Levodopa (LD), which have been found to promote wakefulness. To further appreciate this association, we gathered updated evidence of this novel therapeutic approach and compared it, evaluating its clinical use in an acute stroke setting. We carried out a systematic review of clinical trials conducted exclusively on stroke patients who received levodopa. Four clinical trials were reviewed and analyzed after applying the inclusion/exclusion criteria. The use of levodopa showed positive results in four of the clinical trials, and statistically significant results in 3/4 of the studies; however, more studies need to be conducted to corroborate these results.
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15
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Frase S, Löffler F, Hosp JA. Enhancing Post-Stroke Rehabilitation and Preventing Exo-Focal Dopaminergic Degeneration in Rats-A Role for Substance P. Int J Mol Sci 2022; 23:ijms23073848. [PMID: 35409207 PMCID: PMC8999050 DOI: 10.3390/ijms23073848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Dopaminergic signaling is a prerequisite for motor learning. Delayed degeneration of dopaminergic neurons after stroke is linked to motor learning deficits impairing motor rehabilitation. This study investigates safety and efficacy of substance P (SP) treatment on post-stroke rehabilitation, as this neuropeptide combines neuroprotective and plasticity-promoting properties. Male Sprague Dawley rats received a photothrombotic stroke within the primary motor cortex (M1) after which a previously acquired skilled reaching task was rehabilitated. Rats were treated with intraperitoneal saline (control group, n = 7) or SP-injections (250 µg/kg) 30 min before (SP-pre; n = 7) or 16 h (SP-post; n = 6) after rehabilitation training. Dopaminergic neurodegeneration, microglial activation and substance P-immunoreactivity (IR) were analyzed immunohistochemically. Systemic SP significantly facilitated motor rehabilitation. This effect was more pronounced in SP-pre compared to SP-post animals. SP prevented dopaminergic cell loss after stroke, particularly in the SP-pre condition. Despite its proinflammatory propensity, SP administration did not increase stroke volumes, post-stroke deficits or activation of microglia in the midbrain. Finally, SP administration prevented ipsilesional hypertrophy of striatal SPergic innervation, particularly in the SP-post condition. Mechanistically, SP-pre likely involved plasticity-promoting effects in the early phase of rehabilitation, whereas preservation of dopaminergic signaling may have ameliorated rehabilitative success in both SP groups during later stages of training. Our results demonstrate the facilitating effect of SP treatment on motor rehabilitation after stroke, especially if administered prior to training. SP furthermore prevented delayed dopaminergic degeneration and preserved physiological endogenous SPergic innervation.
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16
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Erler KS, Wu R, DiCarlo JA, Petrilli MF, Gochyyev P, Hochberg LR, Kautz SA, Schwamm LH, Cramer SC, Finklestein SP, Lin DJ. Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke. Neurology 2022; 98:e1877-e1885. [PMID: 35277444 PMCID: PMC9109148 DOI: 10.1212/wnl.0000000000200154] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Precise measurement of outcomes is essential for stroke trials and clinical care. Prior research has highlighted conceptual differences between global outcome measures such as the Modified Rankin Scale (mRS) and domain-specific measures (e.g. motor, sensory, language or cognitive function). This study related motor phenotypes to the mRS, specifically aiming to (1) determine whether mRS levels distinguish motor impairment and function phenotypes, and (2) compare mRS outcomes to meaningful changes in impairment and function from acute to subacute recovery after stroke. METHODS Patients with upper extremity weakness after ischemic stroke were assessed with a battery of impairment and functional measures within the first week and at 90-days post-stroke. Impairment and functional outcomes were examined in relation to 90-day mRS scores. Clinically meaningful changes in motor impairment, activities of daily living, and mobility were examined in relation to 90-day mRS. RESULTS In this cohort of n = 73 stroke patients, impairment and functional outcomes were associated with 90-day mRS scores but showed substantial variability within individual mRS levels: within mRS level 2, upper extremity impairment ranged from near hemiplegia (with an upper extremity Fugl-Meyer 8) to no deficits (upper extremity Fugl-Meyer 66). Overall, there were few differences in impairment and functional outcomes between adjacent mRS levels. While some outcome measures were significantly different between mRS levels 3 and 4 (Nine-Hole Peg, Leg Motor, Gait Velocity, Timed Up and Go, National Institutes of Health Stroke Scale, and Barthel Index), none of the outcome measures differed between mRS levels 1 and 2. Fugl-Meyer and Grip Strength were not different between any adjacent mRS levels. A substantial number of patients experienced clinically meaningful changes in impairment and function in the first 90 days post-stroke but did not achieve good mRS outcome (mRS ≤ 2). CONCLUSIONS The mRS broadly relates to domain-specific outcomes after stroke confirming its established value in stroke trials, but it does not precisely distinguish differences in impairment and function nor does it sufficiently capture meaningful clinical changes across impairment, ADL status, and mobility. These findings underscore the potential utility of incorporating detailed phenotypic measures alongside the mRS in future stroke trials.
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Affiliation(s)
- Kimberly S Erler
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.,Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Rui Wu
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Marina F Petrilli
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Perman Gochyyev
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA.,School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.,Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Lee H Schwamm
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven C Cramer
- Department of Neurology University of California, Los Angeles, CA, USA.,California Rehabilitation Institute, Los Angeles, CA, USA
| | - Seth P Finklestein
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA
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17
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Jang SH, Byun DH. Delayed gait recovery by resolution of limb-kinetic apraxia in a chronic hemiparetic stroke patient: A case report. Medicine (Baltimore) 2022; 101:e28711. [PMID: 35089235 PMCID: PMC8797483 DOI: 10.1097/md.0000000000028711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE This paper reports on a chronic hemiparetic stroke patient who showed delayed gait recovery due to resolution of limb-kinetic apraxia (LKA). PATIENT CONCERNS A 49-year-old man underwent comprehensive rehabilitation at a local rehabilitation hospital since 3 weeks after spontaneous intracerebral haemorrhage. However, he could not walk independently because of severe motor weakness in his right leg until 19 months after the onset. DIAGNOSIS At the beginning of rehabilitation at our hospital (19 months after onset), we thought that he had the neurological potential to walk independently because the unaffected (right) corticospinal tract and corticoreticulospinal tract were closely related to the gait potential, representing intact integrities. As a result, we assumed that the severe motor weakness in the right leg was mainly ascribed to LKA. INTERVENTIONS At our hospital, he underwent comprehensive rehabilitation including increased doses of dopaminergic drugs (pramipexole, ropinirole, amantadine, and carbidopa/levodopa). OUTCOMES After 10 days to our hospital, he could walk independently on an even floor with verbal supervision, concurrent with motor recovery of the right leg. After 24 days after hospital admission, he could walk independently on an even floor. LESSONS We believe that the resolution of LKA in his right leg by the administration of adequate doses of dopaminergic drugs was the main reason for the delayed gait recovery in this patient. The results suggest the importance of detecting the neurological potential for gait ability of a stroke patient who cannot walk after the gait recovery phase and the causes of gait inability for individual patients.
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18
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Stampanoni Bassi M, Iezzi E, Centonze D. Multiple sclerosis: Inflammation, autoimmunity and plasticity. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:457-470. [PMID: 35034754 DOI: 10.1016/b978-0-12-819410-2.00024-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, experimental studies have clarified that immune system influences the functioning of the central nervous system (CNS) in both physiologic and pathologic conditions. The neuro-immune crosstalk plays a crucial role in neuronal development and may be critically involved in mediating CNS response to neuronal damage. Multiple sclerosis (MS) represents a good model to investigate how the immune system regulates neuronal activity. Accordingly, a growing body of evidence has demonstrated that increased levels of pro-inflammatory mediators may significantly impact synaptic mechanisms, influencing overall neuronal excitability and synaptic plasticity expression. In this chapter, we provide an overview of preclinical data and clinical studies exploring synaptic functioning noninvasively with transcranial magnetic stimulation (TMS) in patients with MS. Moreover, we examine how inflammation-driven synaptic dysfunction could affect synaptic plasticity expression, negatively influencing the MS course. Contrasting CSF inflammation together with pharmacologic enhancement of synaptic plasticity and application of noninvasive brain stimulation, alone or in combination with rehabilitative treatments, could improve the clinical compensation and prevent the accumulating deterioration in MS.
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Affiliation(s)
| | - Ennio Iezzi
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy; Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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19
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Liew SL, Lin DJ, Cramer SC. Interventions to Improve Recovery After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Jitsuki S. [CRMP2 binding compound accelerates functional recovery from central nervous system damage]. Nihon Yakurigaku Zasshi 2022; 157:244-247. [PMID: 35781453 DOI: 10.1254/fpj.22011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Brain injury causes temporary or permanent impairment of brain function due to an accident or circulation disorders. Even after rehabilitation training, there are often persistent functional impairments. Recent advances in our understanding of the repair mechanisms of neural circuits after brain injury have led to the possibility that these mechanisms may offer potential therapeutic targets for drugs that promote functional recovery after brain injury. Neuroplasticity is believed to be important for the recovery process after brain injury in the brain regions associated with injured region for compensation. The effectiveness of drugs for restoring brain function after stroke investigated in a variety of animal models and clinical trials has been focused on drugs that act on the monoamine system to modulate neuroplasticity, as well as other targets such as NMDA receptors and CCR5. Recently, we focused on novel small compound, edonerpic maleate, as a drug which facilitates experience-dependent synaptic delivery of AMPA receptor. We found that edonerpic maleate binds to Collapsin-response mediator protein 2, a downstream molecule of Semaphorin and enhance synaptic plasticity by facilitating synaptic delivery of AMPA receptors, thereby promoting functional recovery in a rehabilitation-dependent manner after brain injury in rodents and non-human primates. Further investigations is needed to seek more appropriate drug targets from both preclinical animal studies and clinical trials, and to translate preclinical results into successful clinical trials.
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Affiliation(s)
- Susumu Jitsuki
- Department of Biochemistry, Mie University Graduate school of Medicine
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21
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Sheffler P, Rodriguez TM, Cheung CS, Wu R. Cognitive and metacognitive, motivational, and resource considerations for learning new skills across the lifespan. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2021; 13:e1585. [PMID: 34783458 DOI: 10.1002/wcs.1585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/09/2021] [Accepted: 10/15/2021] [Indexed: 01/09/2023]
Abstract
Across the lifespan, learners have to tackle the challenges of learning new skills. These skills can range from abilities needed for survival, such as learning languages, learning to walk during infancy, and learning new software for a job in adulthood, to abilities related to leisure and hobbies. As the learner progresses through novice to expert stages, there are cognitive and metacognitive, motivational, and resource considerations for learning new skills. In terms of cognitive considerations, fluid and crystallized abilities as well as executive functions interact to help the learner process and retain information related to the skills. In terms of metacognitive considerations, knowing what to learn and how to learn are important for novel skill learning. In terms of motivational considerations, changes in individuals' intrinsic and extrinsic motivation throughout the lifespan impact their pursuit of novel skill learning, and declines in motivation can be buffered through the cultivation of grit, growth mindset, self-efficacy, and other personal factors. In terms of resource considerations, there are many tools that learners can use to acquire new skills, but allocation and availability of these resources differ based on life stage and socioeconomic status. Taken together, these considerations may provide learners with the best chance at acquiring new skills across the lifespan. Further research investigating these three factors, particularly among older adult learners, and their interactive effects could help increase our understanding of their impacts on skill learning and inform future cognitive interventions that can be tailored to learners' unique needs. This article is categorized under: Cognitive Biology > Cognitive Development Psychology > Development and Aging Psychology > Learning.
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Affiliation(s)
- Pamela Sheffler
- Department of Psychology, University of California, Riverside, California, USA
| | - Tania M Rodriguez
- Department of Psychology, University of California, Riverside, California, USA
| | - Cecilia S Cheung
- Department of Psychology, University of California, Riverside, California, USA
| | - Rachel Wu
- Department of Psychology, University of California, Riverside, California, USA
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22
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Inhibitory Effect of Apomorphine on Focal and Nonfocal Plasticity in the Human Motor Cortex. Pharmaceutics 2021; 13:pharmaceutics13050718. [PMID: 34068263 PMCID: PMC8153161 DOI: 10.3390/pharmaceutics13050718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
Dopamine is crucial for neuroplasticity, which is considered to be the neurophysiological foundation of learning and memory. The specific effect of dopamine on plasticity such as long-term potentiation (LTP) and long-term depression (LTD) is determined by receptor subtype specificity, concentration level, and the kind of plasticity induction technique. In healthy human subjects, the dopamine precursor levodopa (L-DOPA) exerts a dosage-dependent non-linear effect on motor cortex plasticity. Low and high dosage L-DOPA impaired or abolished plasticity, while medium-dose preserved and reversed plasticity in previous studies. Similar dosage-dependent effects were also observed for selective D1-like and D2-like receptor activation that favor excitatory and inhibitory plasticity, respectively. However, such a dosage-dependent effect has not been explored for a nonselective dopamine agonist such as apomorphine in humans. To this aim, nonfocal and focal motor cortex plasticity induction using paired associative stimulation (PAS) and transcranial direct current stimulation (tDCS) were performed respectively in healthy participants under 0.1, 0.2, 0.3 mg apomorphine or placebo drug. Transcranial magnetic stimulation-elicited motor-evoked potentials were used to monitor motor cortical excitability alterations. We hypothesized that, similar to L-DOPA, apomorphine will affect motor cortex plasticity. The results showed that apomorphine with the applied dosages has an inhibitory effect for focal and nonfocal LTP-like and LTD-like plasticity, which was either abolished, diminished or reversed. The detrimental effect on plasticity induction under all dosages of apomorphine suggests a predominantly presynaptic mechanism of action of these dosages.
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23
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Role of the nucleus accumbens in functional recovery from spinal cord injury. Neurosci Res 2021; 172:1-6. [PMID: 33895202 DOI: 10.1016/j.neures.2021.04.006] [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: 10/28/2020] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022]
Abstract
Post brain damage depression impedes functional recovery. On the other hand, higher motivation facilitates functional recovery after damage to the central nervous system, but the neural mechanism of psychological effects on functional recovery is unclear. The nucleus accumbens (NAcc), a motivation center, has not been considered directly involved in motor function. Recently, it was demonstrated that the NAcc makes a direct contribution to motor performance after spinal cord injury by facilitating motor cortex activity. In this perspective, we first summarize our investigation of role of NAcc in motor control during the recovery course after spinal cord injury, followed by a discussion of the current knowledge regarding the relationship between the recovery and NAcc after neuronal damage.
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24
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Lin DJ, Cramer SC. Principles of Neural Repair and Their Application to Stroke Recovery Trials. Semin Neurol 2021; 41:157-166. [PMID: 33663003 DOI: 10.1055/s-0041-1725140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neural repair is the underlying therapeutic strategy for many treatments currently under investigation to improve recovery after stroke. Repair-based therapies are distinct from acute stroke strategies: instead of salvaging threatened brain tissue, the goal is to improve behavioral outcomes on the basis of experience-dependent brain plasticity. Furthermore, timing, concomitant behavioral experiences, modality specific outcome measures, and careful patient selection are fundamental concepts for stroke recovery trials that can be deduced from principles of neural repair. Here we discuss core principles of neural repair and their implications for stroke recovery trials, highlighting related issues from key studies in humans. Research suggests a future in which neural repair therapies are personalized based on measures of brain structure and function, genetics, and lifestyle factors.
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Affiliation(s)
- David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, Rhode Island
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, California.,California Rehabilitation Institute, Los Angeles, California
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25
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Sommer CJ, Schäbitz WR. Principles and requirements for stroke recovery science. J Cereb Blood Flow Metab 2021; 41:471-485. [PMID: 33175596 PMCID: PMC7907998 DOI: 10.1177/0271678x20970048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
The disappointing results in bench-to-bedside translation of neuroprotective strategies caused a certain shift in stroke research towards enhancing the endogenous recovery potential of the brain. One reason for this focus on recovery is the much wider time window for therapeutic interventions which is open for at least several months. Since recently two large clinical studies using d-amphetamine or fluoxetine, respectively, to enhance post-stroke neurological outcome failed again it is a good time for a critical reflection on principles and requirements for stroke recovery science. In principal, stroke recovery science deals with all events from the molecular up to the functional and behavioral level occurring after brain ischemia eventually ending up with any measurable improvement of various clinical parameters. A detailed knowledge of the spontaneously occurring post-ischemic regeneration processes is the indispensable prerequisite for any therapeutic approaches aiming to modify these responses to enhance post-stroke recovery. This review will briefly illuminate the molecular mechanisms of post-ischemic regeneration and the principle possibilities to foster post-stroke recovery. In this context, recent translational approaches are analyzed. Finally, the principal and specific requirements and pitfalls in stroke recovery research as well as potential explanations for translational failures will be discussed.
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Affiliation(s)
- Clemens J Sommer
- Institute of Neuropathology, University Medical Center of the
Johannes Gutenberg-University Mainz, Mainz, Germany
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26
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Tian W, Chen S. Neurotransmitters, Cell Types, and Circuit Mechanisms of Motor Skill Learning and Clinical Applications. Front Neurol 2021; 12:616820. [PMID: 33716924 PMCID: PMC7947691 DOI: 10.3389/fneur.2021.616820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023] Open
Abstract
Animals acquire motor skills to better survive and adapt to a changing environment. The ability to learn novel motor actions without disturbing learned ones is essential to maintaining a broad motor repertoire. During motor learning, the brain makes a series of adjustments to build novel sensory–motor relationships that are stored within specific circuits for long-term retention. The neural mechanism of learning novel motor actions and transforming them into long-term memory still remains unclear. Here we review the latest findings with regard to the contributions of various brain subregions, cell types, and neurotransmitters to motor learning. Aiming to seek therapeutic strategies to restore the motor memory in relative neurodegenerative disorders, we also briefly describe the common experimental tests and manipulations for motor memory in rodents.
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Affiliation(s)
- Wotu Tian
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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27
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Exercise preconditioning ameliorates cognitive impairment and anxiety-like behavior via regulation of dopamine in ischemia rats. Physiol Behav 2021; 233:113353. [PMID: 33571546 DOI: 10.1016/j.physbeh.2021.113353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/31/2020] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
Cognitive impairment and anxiety are common health problems in acute ischemic stroke patients. Meanwhile, dopamine in the striatal brain region is significantly increased during the acute phase of cerebral ischemia. Besides, the studies shown that striatum and change of striatal dopamine are associated with learning and memory and anxiety. Further, physical exercise has been shown to improve neurocognitive and emotional function in animal models and patients with cerebral ischemia. However, the exact mechanism underlying this effect is unclear. The purpose of this research is to explore the effect of pre-ischemic voluntary wheel running on levels of striatal dopamine, cognition and anxiety in cerebral ischemia rats. METHODS 48 adult male Sprague-Dawley rats were enrolled in this study and divided randomly in following 6 groups: sham group (S group, n = 8), ischemia group (I group, n = 8), 1 week wheel running group (1R group), 4 weeks wheel running group (4R group), 1 week pre-ischemia wheel running group (1RI group, n = 8) and 4 weeks pre-ischemia wheel running group (4RI group, n = 8). After training, cerebral ischemia was induced by permanent bilateral common carotid artery ligation (2-VO) operation. Microdialysis was used to collect dialysates from the striatum immediately from 30 min before ischemia to 90 min after ischemia. High-performance liquid chromatography-electrochemical detection system (HPLC) was used to determine the content of dopamine in the dialysates. Passive avoidance and elevated plus maze test were used to test neurocognitive function 24 h after 2-VO cerebral ischemia. RESULTS As compare with the constant striatal dopamine level of S group, the striatal dopamine level in I group after ischemia showed a trend of rapid increasing and reached maximum value at the 20 min (P<0.001), then decreased gradually. The striatal dopamine level in 1RI and 4RI group showed the trend were similar to I group, but the increasing magnitude was attenuated. A comparison of the basal striatal dopamine level in 4 groups found that the basal dopamine level in 1RI and 4RI group were higher than S and I group (P<0.001). In passive avoidance task, the retention latency of I group was significantly shorter than S group (P<0.001), and the retention latency of the 1RI, 1R and 4R, 4RI group were longer than I group (P<0.001), there was no significant difference in S, 1RI, 1R, 4R and 4RI group (P>0.05). In elevated plus maze test, the time and entrance numbers of open arms in I group were significantly less than S group (P<0.05), but these indices were no significant difference in S, 1RI, 1R, 4RI and 4RI group. CONCLUSION According to our results, 1 or 4 weeks pre-ischemia wheel running can significantly increase the basal dopamine level, attenuate the increase of striatal dopamine induced by cerebral ischemia and improve neurocognitive function in ischemia rats.
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Kakehi S, Tompkins DM. A Review of Pharmacologic Neurostimulant Use During Rehabilitation and Recovery After Brain Injury. Ann Pharmacother 2021; 55:1254-1266. [PMID: 33435717 DOI: 10.1177/1060028020983607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the efficacy and safety of pharmacologic neurostimulants after neurological injuries such as ischemic or hemorrhagic stroke and traumatic brain injury (TBI), critically evaluate the available literature, and make recommendations regarding which neurostimulants should be considered for use in clinical practice. DATA SOURCES A literature search of PubMed was performed (1953 to October 2020) to identify relevant articles. Search terms included the following: "neurostimulant, neurorehabilitation" AND "traumatic brain injury, cerebrovascular accident, or stroke." This review is limited to prospective studies and observational trials. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies conducted in humans were considered. DATA SYNTHESIS Cognitive and motor deficits caused by stroke and TBI account for high rates of long-term disability. Although not well-established, pharmacologic agents, broadly characterized as neurostimulants, may be prescribed after brain injury to treat these deficits. When prescribing these medications, it is imperative to be aware of the supporting evidence in order to accurately gauge the risk-benefit profile of each agent. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The following presents a literature review critically evaluating clinical studies that investigate neurostimulant use after brain injury. The intent of this review is to serve as an evidence-based guide for clinicians. CONCLUSIONS The pharmacologic agent with the most supporting literature is amantadine used for cognitive improvement after TBI. Other neurostimulants with positive, despite more limited, evidence include methylphenidate, modafinil, levodopa, and citalopram. Caution is warranted with other neurostimulants given higher rates of adverse effects or lack of benefit observed in clinical trials.
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Affiliation(s)
- Sumie Kakehi
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Danielle M Tompkins
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.,Hackensack University Medical Center, Hackensack, NJ, USA
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Abstract
PURPOSE OF REVIEW This article describes restorative therapies to improve patient outcomes after stroke. These therapies contrast with acute stroke treatments such as recombinant tissue plasminogen activator (rtPA) and thrombectomy that target clots, aim to salvage threatened brain tissue to limit injury, and have a time window measured in hours. Restorative therapies target the brain, aim to promote plasticity within surviving brain tissue, and have a time window measured in days to weeks or longer. RECENT FINDINGS A number of drugs are under study. Preclinical studies are providing attractive therapeutic candidates for translation, such as the C-C chemokine receptor 5 inhibitor maraviroc. Some drug studies have used a pragmatic approach, which is premature for the nascent field of neural repair. Substantial data support the utility of activity-dependent therapies, including constraint-induced movement therapy, with recent studies supporting the need for very high doses to generate the best functional gains. While stem cell therapies are at an early stage, mounting preclinical evidence supports the efficacy of mesenchymal stem cells; some initial human studies are supportive. Several types of brain stimulation have been examined, and in some cases initial studies are promising. SUMMARY Improved insights into stroke recovery and its treatment have the potential to reduce disability in a large segment of stroke survivors.
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Wang W, Liu X, Yang Z, Shen H, Liu L, Yu Y, Zhang T. Levodopa Improves Cognitive Function and the Deficits of Structural Synaptic Plasticity in Hippocampus Induced by Global Cerebral Ischemia/Reperfusion Injury in Rats. Front Neurosci 2020; 14:586321. [PMID: 33328857 PMCID: PMC7734175 DOI: 10.3389/fnins.2020.586321] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022] Open
Abstract
The cognitive impairment caused by cerebral ischemia/reperfusion is an unsolved problem in the field of international neural rehabilitation. Not only ameliorates the consciousness level of certain patients who suffered from ischemia-reperfusion injury and were comatose for a long time period after cerebral resuscitation treatment, but levodopa also improves the symptoms of neurological deficits in rats with global cerebral ischemia-reperfusion injury. However, Levodopa has not been widely used as a brain protection drug after cardiopulmonary resuscitation, because of its unclear repair mechanism. Levodopa was used to study the neuroplasticity in the hippocampus of global cerebral ischemia/reperfusion injury rat model, established by Pulsinelli's four-vessel occlusion method. Levodopa was injected intraperitoneally at 50 mg/kg/d for 7 consecutive days after 1st day of surgery. The modified neurological function score, Morris water maze, magnetic resonance imaging, Nissl and TH staining, electron microscopy and western blot were used in the present study. The results showed that levodopa improved the neurological function and learning and memory of rats after global cerebral ischemia/reperfusion injury, improved the integrity of white matter, and density of gray matter in the hippocampus, increased the number of synapses, reduced the delayed neuronal death, and increased the expression of synaptic plasticity-related proteins (BDNF, TrkB, PSD95, and Drebrin) in the hippocampus. In conclusion, levodopa can improve cognitive function after global cerebral ischemia/reperfusion injury by enhancing the synaptic plasticity in the hippocampus.
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Affiliation(s)
- Wenzhu Wang
- Chinese Institute of Rehabilitation Science, China Rehabilitation Science Institute, Beijing, China.,Beijing Key Laboratory of Neural Injury and Rehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Xu Liu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Zhengyi Yang
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Hui Shen
- School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Lixu Liu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China.,Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yan Yu
- Chinese Institute of Rehabilitation Science, China Rehabilitation Science Institute, Beijing, China.,Beijing Key Laboratory of Neural Injury and Rehabilitation, China Rehabilitation Research Center, Beijing, China.,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Tong Zhang
- Chinese Institute of Rehabilitation Science, China Rehabilitation Science Institute, Beijing, China.,Beijing Key Laboratory of Neural Injury and Rehabilitation, China Rehabilitation Research Center, Beijing, China.,Institute of Automation, Chinese Academy of Sciences, Beijing, China
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Ford GA, Bhakta BB, Cozens A, Hartley S, Holloway I, Meads D, Pearn J, Ruddock S, Sackley CM, Saloniki EC, Santorelli G, Walker MF, Farrin AJ. Safety and efficacy of co-careldopa as an add-on therapy to occupational and physical therapy in patients after stroke (DARS): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2020; 18:530-538. [PMID: 31122493 PMCID: PMC6527868 DOI: 10.1016/s1474-4422(19)30147-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/20/2018] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dopamine is a key modulator of striatal function and learning and might improve motor recovery after stroke. Previous small trials of dopamine agonists after stroke provide equivocal evidence of effectiveness on improving motor recovery. We aimed to assess the safety and efficacy of co-careldopa plus routine occupational and physical therapy during early rehabilitation after stroke. METHODS This double-blind, multicentre, randomised controlled trial of co-careldopa versus placebo in addition to routine NHS occupational and physical therapy was done at 51 UK NHS acute inpatient stroke rehabilitation services. We recruited patients with new or recurrent clinically diagnosed ischaemic or haemorrhagic (excluding subarachnoid haemorrhage) stroke 5-42 days before randomisation, who were unable to walk 10 m or more, had a score of less than 7 points on the Rivermead Mobility Index, were expected to need rehabilitation, and were able to access rehabilitation after discharge from hospital. Participants were assigned (1:1) using stratified random blocks to receive 6 weeks of oral co-careldopa or matched placebo in addition to routine NHS physiotherapy and occupational therapy. The initial two doses of co-careldopa were 62·5 mg (50 mg of levodopa and 12·5 mg of carbidopa) and the remaining doses were 125 mg (100 mg of levodopa and 25 mg of carbidopa). Participants were required to take a single oral tablet 45-60 min before physiotherapy or occupational therapy session. The primary outcome was ability to walk independently, defined as a Rivermead Mobility Index score of 7 or more, at 8 weeks. Primary and safety analyses were done in the intention-to-treat population. The trial is registered on the ISRCTN registry, number ISRCTN99643613. FINDINGS Between May 30, 2011, and March 28, 2014, of 1574 patients found eligible, 593 (mean age 68·5 years) were randomly assigned to either the co-careldopa group (n=308) or to the placebo group (n=285), on an average 18 days after stroke onset. Primary outcome data were available for all 593 patients. We found no evidence that the ability to walk independently improved with co-careldopa (125 [41%] of 308 patients) compared with placebo (127 [45%] of 285 patients; odds ratio 0·78 [95% CI 0·53-1·15]) at 8 weeks. Mortality at 12 months did not differ between the two groups (22 [7%] vs 17 [6%]). Serious adverse events were largely similar between groups. Vomiting during therapy sessions, after taking the study drug, was the most frequent adverse event and was more frequent in the co-careldopa group than the placebo group (19 [6·2%] vs 9 [3·2%]). INTERPRETATION Co-careldopa in addition to routine occupational and physical therapy does not seem to improve walking after stroke. Further research might identify subgroups of patients with stroke who could benefit from dopaminergic therapy at different doses or times after stroke with more intensive motor therapy. FUNDING Medical Research Council.
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Affiliation(s)
- Gary A Ford
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK.
| | - Bipin B Bhakta
- The Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John Pearn
- The Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sharon Ruddock
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine M Sackley
- School of Population and Environmental Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Eirini-Christina Saloniki
- Centre for Health Services Studies and Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Gillian Santorelli
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Marion F Walker
- Rehabilitation and Ageing, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Abstract
Purpose of review Stroke is a devastating illness which severely attenuates quality of life because of paralysis. Despite recent advances in therapies during acute phase such as thrombolytic therapy, clinical option to intervene the process of rehabilitation is limited. No pharmacological intervention that could enhance the effect of rehabilitation has not been established. Recent articles, which are summarized in the review article, reported novel small compound which accelerates training-dependent motor function recovery after brain damage. Recent findings A novel small compound, edonerpic maleate, binds to collapsin response mediator protein 2 (CRMP2) and enhance synaptic plasticity leading to the acceleration of rehabilitative training-dependent functional recovery after brain damage in rodent and nonhuman primate. The clinical trial to test this effect in human is now ongoing. Future preclinical and clinical studies will delineate the potentials of this compound. Summary A novel CRMP2-binding small compound, edonerpic maleate, accelerates motor function recovery after brain damage in rodent and nonhuman primate.
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WORLEY GORDON, ERICKSON STEPHENW, GUSTAFSON KATHRYNE, NIKOLOVA YULIYAS, ASHLEY-KOCH ALLISONE, BELSKY DANIELW, GOLDSTEIN RICKIF, LEVY JOSHUAL, MCDONALD SCOTTA, PAGE GRIERP, COTTEN CMICHAEL. Genetic variation in dopamine neurotransmission and motor development of infants born extremely-low-birthweight. Dev Med Child Neurol 2020; 62:750-757. [PMID: 31691959 PMCID: PMC7200269 DOI: 10.1111/dmcn.14383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/31/2022]
Abstract
AIM To determine if genetic variation associated with decreased dopamine neurotransmission predicts a decrease in motor development in a convenience cohort study of infants born extremely-low-birthweight (ELBW). METHOD Four hundred and ninety-eight infants born ELBW had genome-wide genotyping and a neurodevelopmental evaluation at 18 to 22 months of age, corrected for preterm birth. A polygenic risk score (PRS) was created to combine into one predictor variable the hypothesized influences on motor development of alleles at seven independent single nucleotide polymorphisms previously associated with relative decreases in both dopamine neurotransmission and motor learning, by summing the number of alleles present in each infant (range=0-14). The motor development outcome was the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development, Second Edition. The linear regression models were adjusted for seven clinical and four genetic ancestry covariates. The mean PRS of infants with cerebral palsy (CP) was compared to those without CP. RESULTS PRS was inversely related to PDI (p=0.011). Each 1-point increase in PRS resulted in an average decrease in PDI of 1.37 points. Patients with CP did not have a greater mean PRS than those without (p=0.67), both with and without adjustment for covariates. INTERPRETATION Genetic variation that favors a decrease in dopamine neurotransmission predisposes to a decrease in motor development in infants born ELBW, but not to the diagnosis of CP. WHAT THIS PAPER ADDS Genetic variation in dopamine neurotransmission was associated with a decrease in motor development in infants born at an extremely-low-birthweight. It does not predispose to the diagnosis of cerebral palsy.
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Affiliation(s)
- GORDON WORLEY
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University Medical Center, Durham, N.C. U.SA
| | - STEPHEN W ERICKSON
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - KATHRYN E GUSTAFSON
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham N.C., U.S.A
| | - YULIYA S NIKOLOVA
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - ALLISON E ASHLEY-KOCH
- Duke Molecular Physiology Institute, Department of Medicine, Duke University Medical Center, Durham N.C., U.S.A
| | - DANIEL W BELSKY
- Department of Population Health Sciences, Duke University, Durham N.C., U.S.A
| | - RICKI F GOLDSTEIN
- Division of Neonatology, Department of Pediatrics, Kentucky Children’s Hospital, University of Kentucky Chandler Medical Center, Lexington, K.Y., U.S.A
| | - JOSHUA L LEVY
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - SCOTT A MCDONALD
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - GRIER P PAGE
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - C MICHAEL COTTEN
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham N.C., U.S.A
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Coscia M, Wessel MJ, Chaudary U, Millán JDR, Micera S, Guggisberg A, Vuadens P, Donoghue J, Birbaumer N, Hummel FC. Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke. Brain 2020; 142:2182-2197. [PMID: 31257411 PMCID: PMC6658861 DOI: 10.1093/brain/awz181] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/14/2019] [Accepted: 05/12/2019] [Indexed: 01/27/2023] Open
Abstract
Upper limb motor deficits in severe stroke survivors often remain unresolved over extended time periods. Novel neurotechnologies have the potential to significantly support upper limb motor restoration in severely impaired stroke individuals. Here, we review recent controlled clinical studies and reviews focusing on the mechanisms of action and effectiveness of single and combined technology-aided interventions for upper limb motor rehabilitation after stroke, including robotics, muscular electrical stimulation, brain stimulation and brain computer/machine interfaces. We aim at identifying possible guidance for the optimal use of these new technologies to enhance upper limb motor recovery especially in severe chronic stroke patients. We found that the current literature does not provide enough evidence to support strict guidelines, because of the variability of the procedures for each intervention and of the heterogeneity of the stroke population. The present results confirm that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients, but the combination of interventions often lacks understanding of single intervention mechanisms of action, which may not reflect the summation of single intervention’s effectiveness. Stroke rehabilitation is a long and complex process, and one single intervention administrated in a short time interval cannot have a large impact for motor recovery, especially in severely impaired patients. To design personalized interventions combining or proposing different interventions in sequence, it is necessary to have an excellent understanding of the mechanisms determining the effectiveness of a single treatment in this heterogeneous population of stroke patients. We encourage the identification of objective biomarkers for stroke recovery for patients’ stratification and to tailor treatments. Furthermore, the advantage of longitudinal personalized trial designs compared to classical double-blind placebo-controlled clinical trials as the basis for precise personalized stroke rehabilitation medicine is discussed. Finally, we also promote the necessary conceptual change from ‘one-suits-all’ treatments within in-patient clinical rehabilitation set-ups towards personalized home-based treatment strategies, by adopting novel technologies merging rehabilitation and motor assistance, including implantable ones.
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Affiliation(s)
- Martina Coscia
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Maximilian J Wessel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Ujwal Chaudary
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - José Del R Millán
- Defitech Chair in Brain-Machine Interface, Center for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland.,Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, 56025, Italy
| | - Adrian Guggisberg
- Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
| | | | - John Donoghue
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland.,Department of Neuroscience, Brown University, Providence, RI 02906, USA
| | - Niels Birbaumer
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland.,Institute of Medical Psychology and Behavioral Neurobiology, University Tuebingen, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland.,Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
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Szelenberger R, Kostka J, Saluk-Bijak J, Miller E. Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery. Curr Neuropharmacol 2020; 18:51-64. [PMID: 31362657 PMCID: PMC7327936 DOI: 10.2174/1570159x17666190726104139] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
Neuroplasticity is a natural process occurring in the brain for the entire life. Stroke is the leading cause of long term disability and a huge medical and financial problem throughout the world. Research conducted over the past decade focused mainly on neuroprotection in the acute phase of stroke while very little studies target the chronic stage. Recovery after stroke depends on the ability of our brain to reestablish the structural and functional organization of neurovascular networks. Combining adjuvant therapies and drugs may enhance the repair processes and restore impaired brain functions. Currently, there are some drugs and rehabilitative strategies that can facilitate brain repair and improve clinical effect even years after stroke onset. Moreover, some of the compounds such as citicoline, fluoxetine, niacin, levodopa, etc. are already in clinical use or are being trialed in clinical issues. Many studies are also testing cell therapies; in our review, we focused on studies where cells have been implemented at the early stage of stroke. Next, we discuss pharmaceutical interventions. In this section, we selected methods of cognitive, behavioral, and physical rehabilitation as well as adjuvant interventions for neuroprotection including noninvasive brain stimulation and extremely low-frequency electromagnetic field. The modern rehabilitation represents a new model of physical interventions with the limited therapeutic window up to six months after stroke. However, previous studies suggest that the time window for stroke recovery is much longer than previously thought. This review attempts to present the progress in neuroprotective strategies, both pharmacological and non-pharmacological that can stimulate the endogenous neuroplasticity in post-stroke patients.
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Affiliation(s)
- Rafał Szelenberger
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Joanna Kostka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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Micera S, Caleo M, Chisari C, Hummel FC, Pedrocchi A. Advanced Neurotechnologies for the Restoration of Motor Function. Neuron 2020; 105:604-620. [PMID: 32078796 DOI: 10.1016/j.neuron.2020.01.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/23/2023]
Abstract
Stroke is one of the leading causes of long-term disability. Advanced technological solutions ("neurotechnologies") exploiting robotic systems and electrodes that stimulate the nervous system can increase the efficacy of stroke rehabilitation. Recent studies on these approaches have shown promising results. However, a paradigm shift in the development of new approaches must be made to significantly improve the clinical outcomes of neurotechnologies compared with those of traditional therapies. An "evolutionary" change can occur only by understanding in great detail the basic mechanisms of natural stroke recovery and technology-assisted neurorehabilitation. In this review, we first describe the results achieved by existing neurotechnologies and highlight their current limitations. In parallel, we summarize the data available on the mechanisms of recovery from electrophysiological, behavioral, and anatomical studies in humans and rodent models. Finally, we propose new approaches for the effective use of neurotechnologies in stroke survivors, as well as in people with other neurological disorders.
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Affiliation(s)
- Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Matteo Caleo
- Department of Biomedical Sciences, University of Padova, Padova, Italy; Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - Carmelo Chisari
- Neurorehabilitation Section, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
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Abstract
Recently, in the field of stroke rehabilitation, some novel concepts and therapeutic interventions have been proposed. It seems that earlier mobilization for acute stroke patients could lead to better functional outcome. In addition, neural plasticity during acute phase of stroke is enhanced, which means that this phase of stroke could be the period when the patients are likely to respond to rehabilitation training. In the future, acute rehabilitation should be aggressively provided in stroke centers in Japan. Some interventions such as non-invasive brain stimulation, centrally-acting drugs and vagus nerve stimulation have been reported to enhance neural plasticity. If these interventions are introduced combined with rehabilitation training, compensatory mechanism for impaired neurological function could be facilitated, leading to further functional recovery. Some robotic devices to support joint movements of the limbs externally have been developed. Robot-assisted rehabilitation can improve the efficacy of rehabilitation training, especially when applied for gait training. Neurofeedback is a sophisticated training system applying real-time monitoring of brain activity with the use of functional neuroimaging. Neurofeedback can be introduced in order to remedy motor imagery of stroke patients even if motor function is severely impaired. Regenerative therapy is a promising therapeutic intervention and some institutions in Japan have already started to introduce this therapy for stroke patients. It is proposed that rehabilitation training should be provided following the introduction of regenerative therapy so that structural reorganization caused by the therapy could lead to beneficial functional reorganization of the damaged brain. With the aim of improving active motor functions of hemiparetic limbs, botulinum toxin injection for limb spasticity after stroke should be combined with rehabilitation training. If these concepts and interventions are introduced aggressively and more widely for stroke patients, it is expected that functional outcome of such patients could be generally improved.
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Affiliation(s)
- Wataru Kakuda
- Department of Rehabilitation Medicine, International University of Health and Welfare School of Medicine
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Grau-Sánchez J, Münte TF, Altenmüller E, Duarte E, Rodríguez-Fornells A. Potential benefits of music playing in stroke upper limb motor rehabilitation. Neurosci Biobehav Rev 2020; 112:585-599. [PMID: 32092314 DOI: 10.1016/j.neubiorev.2020.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022]
Abstract
Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings.
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Affiliation(s)
- Jennifer Grau-Sánchez
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Catalonia, Spain.
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama and Media, Hannover, Germany
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Department of Cognition, Development and Educational Science, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
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Latifi-Pour M, Hassanian-Moghaddam H, Mortazavi HS, Shadnia S, Zamani N, Rahimi M. The Effect of Methylphenidate on Reed Scaling in Benzodiazepine Poisoning: A Prospective Trial. CURRENT CLINICAL PHARMACOLOGY 2020; 15:81-88. [PMID: 30648520 PMCID: PMC7366007 DOI: 10.2174/1574884714666190112153157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/09/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Benzodiazepine is one of the most important causes of substance abuse and intoxication throughout the world and Iran. OBJECTIVE The aim of our study is to determine the role of stimulants in reversing CNS level in acute Benzodiazepine poisoning patients who were hospitalized at referral poison center. METHOD This was a randomized double-blind placebo-controlled trial study on 32 cases with pure acute Benzodiazepine poisoning from March 2016 to February 2017. Diagnosis of pure acute poisoning was based on history, and laboratory confirmation. We gathered the demographics, clinical data, laboratory data, hospitalization and outcome. Participants were randomized into two groups: Methylphenidate Group (MPH) and Placebo Group (PBO). RESULTS The randomized sample consisted of 32 participants who were predominately female (83%). The majority of the PBO group and the MPH group reported improvement in their consciousness with a significant difference between the two groups (p = .005). Paired sample t-test analyses on Reed Scale data revealed an increase in the probability of improvement during the trial for the MPH group compared to the PBO group. Furthermore, the HCo3 (bicarbonate) level has a significant p-value with respect to age groups (p = .02). None of our cases required either the ICU facility or intubation. CONCLUSION Our study provided the MPH superiority over PBO in reversing CNS symptoms in loss of consciousness in acute BZD poisoned patients. Thus, this trial provides concrete evidence that improvement in consciousness levels (Reed Scale rated) among those patients receiving MPH was associated with a methylphenidate use.
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Affiliation(s)
- Masoud Latifi-Pour
- Toxicological Research Center and Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, Shahid Beheshti University of Medical Sciences, Kamali Avenue, South Karegar Street, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center and Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, Shahid Beheshti University of Medical Sciences, Kamali Avenue, South Karegar Street, Tehran, Iran
| | - Helya-Sadat Mortazavi
- Toxicological Research Center and Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, Shahid Beheshti University of Medical Sciences, Kamali Avenue, South Karegar Street, Tehran, Iran
| | - Shahin Shadnia
- Toxicological Research Center and Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, Shahid Beheshti University of Medical Sciences, Kamali Avenue, South Karegar Street, Tehran, Iran
| | - Nasim Zamani
- Toxicological Research Center and Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, Shahid Beheshti University of Medical Sciences, Kamali Avenue, South Karegar Street, Tehran, Iran
| | - Mitra Rahimi
- Toxicological Research Center and Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, Shahid Beheshti University of Medical Sciences, Kamali Avenue, South Karegar Street, Tehran, Iran
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Regenhardt RW, Takase H, Lo EH, Lin DJ. Translating concepts of neural repair after stroke: Structural and functional targets for recovery. Restor Neurol Neurosci 2020; 38:67-92. [PMID: 31929129 PMCID: PMC7442117 DOI: 10.3233/rnn-190978] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is among the most common causes of adult disability worldwide, and its disease burden is shifting towards that of a long-term condition. Therefore, the development of approaches to enhance recovery and augment neural repair after stroke will be critical. Recovery after stroke involves complex interrelated systems of neural repair. There are changes in both structure (at the molecular, cellular, and tissue levels) and function (in terms of excitability, cortical maps, and networks) that occur spontaneously within the brain. Several approaches to augment neural repair through enhancing these changes are under study. These include identifying novel drug targets, implementing rehabilitation strategies, and developing new neurotechnologies. Each of these approaches has its own array of different proposed mechanisms. Current investigation has emphasized both cellular and circuit-based targets in both gray and white matter, including axon sprouting, dendritic branching, neurogenesis, axon preservation, remyelination, blood brain barrier integrity, blockade of extracellular inhibitory signals, alteration of excitability, and promotion of new brain cortical maps and networks. Herein, we review for clinicians recovery after stroke, basic elements of spontaneous neural repair, and ongoing work to augment neural repair. Future study requires alignment of basic, translational, and clinical research. The field continues to grow while becoming more clearly defined. As thrombolysis changed stroke care in the 1990 s and thrombectomy in the 2010 s, the augmentation of neural repair and recovery after stroke may revolutionize care for these patients in the coming decade.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Hajime Takase
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - David J Lin
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
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Briggs RG, Ahsan SA, Conner AK, Nix CE, Jacobs CC, Jones RG, Sheets JR, Palejwala AH, Chendeb K, Sughrue ME. Neurochemical supplementation in patients with depressed levels of participation after brain tumor surgery: Rationale and preliminary results. J Clin Neurosci 2019; 71:93-96. [PMID: 31771803 DOI: 10.1016/j.jocn.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
A unique challenge in some brain tumor patients is the fact that tumors arising in certain areas of the brain involve the neural structures of consciousness or alertness, limiting the patient's ability to participate in rehabilitation following surgery. A critical question is whether neurostimulant therapy can help patients participate in rehabilitation efforts. We performed a retrospective review of all patients undergoing brain tumor surgery by the senior author from 2012 to 2018. We limited this study to patients with tumors occupying critical structures related to consciousness, alertness, and motor initiation. A combination of methylphenidate and levodopa/carbidopa was used to monitor the progress of patients through neurorehabilitation efforts. We identified 101 patients who experienced an inability to participate in rehabilitation (ITPR) in the post-operative period. Of these, 86 patients (85%) were treated with methylphenidate and levodopa/carbidopa. Cases of ITPR were related to dysfunction of the brainstem (12/86 cases, 14%), thalamus (17/86 cases, 20%), hypothalamus (14/86 cases, 16%), basal ganglia (13/86 cases, 15%), and medial frontal lobe (30/86 cases, 35%). Of the 86 individuals treated, 47/86 patients (55%) showed early improvement in their ability to participate with rehabilitation. At three month follow-up, 58/86 patients (67%) had returned to living independently or were at least interactive and cooperative during follow-up examination. This feasibility report suggests that combined therapy with methylphenidate and levodopa/carbidopa may help patients participate in neurorehabilitation efforts in the immediate post-operative period following brain tumor surgery. Randomized, controlled clinical trials are needed to explore this concept more thoroughly.
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Affiliation(s)
- Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - Syed A Ahsan
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - Cameron E Nix
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - Christina C Jacobs
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - Ryan G Jones
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - John R Sheets
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - Ali H Palejwala
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, Australia
| | - Kassem Chendeb
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - Michael E Sughrue
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
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Affiliation(s)
- Hiroki Abe
- From the Department of Physiology, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan (H.A., S.J., T.T.).,Department of Neurology, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan (H.A.)
| | - Susumu Jitsuki
- From the Department of Physiology, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan (H.A., S.J., T.T.)
| | - Takuya Takahashi
- From the Department of Physiology, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan (H.A., S.J., T.T.)
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Activated CD8+ T Cells Cause Long-Term Neurological Impairment after Traumatic Brain Injury in Mice. Cell Rep 2019; 29:1178-1191.e6. [DOI: 10.1016/j.celrep.2019.09.046] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/08/2019] [Accepted: 09/16/2019] [Indexed: 12/28/2022] Open
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Engelter S, Hemkens LG, Speich B, Traenka C. Dopaminergic agents versus control for enhancing stroke recovery and rehabilitation. Hippokratia 2019. [DOI: 10.1002/14651858.cd013416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stefan Engelter
- Felix Platter Hospital; University Hospital Basel; University of Basel; University Center of Ageing & Rehabilitation; Stroke Center and Neurology; Department of Clinical Research; Petersgraben 4 Basel Switzerland 4031
| | - Lars G Hemkens
- University of Basel; Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research; Spitalstrasse 12 Basel Germany CH-4031
| | - Benjamin Speich
- University Hospital Basel and University of Basel; Basel Institute for Clinical Epidemiology and Biostatistics; Basel Switzerland
| | - Christopher Traenka
- University Hospital and University of Basel; Department of Neurology and Stroke Center; Basel Switzerland
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Influencing neuroplasticity in stroke treatment with advanced biomaterials-based approaches. Adv Drug Deliv Rev 2019; 148:204-218. [PMID: 30579882 DOI: 10.1016/j.addr.2018.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/05/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023]
Abstract
Since the early 1990s, we have known that the adult brain is not static and has the capacity to repair itself. The delivery of various therapeutic factors and cells have resulted in some exciting pre-clinical and clinical outcomes in stroke models by targeting post-injury plasticity to enhance recovery. Developing a deeper understanding of the pathways that modulate plasticity will enable us to optimize delivery strategies for therapeutics and achieve more robust effects. Biomaterials are a key tool for the optimization of these potential treatments, owing to their biocompatibility and tunability. In this review, we identify factors and targets that impact plastic processes known to contribute to recovery, discuss the role of biomaterials in enhancing the efficacy of treatment strategies, and suggest combinatorial approaches based on the stage of injury progression.
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Stinear CM. Dopamine for motor recovery after stroke: where to from here? Lancet Neurol 2019; 18:514-515. [DOI: 10.1016/s1474-4422(19)30162-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Bradley CL, Damiano DL. Effects of Dopamine on Motor Recovery and Training in Adults and Children With Nonprogressive Neurological Injuries: A Systematic Review. Neurorehabil Neural Repair 2019; 33:331-344. [PMID: 30913975 DOI: 10.1177/1545968319837289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The strong link between dopamine and motor learning has been well-established in the animal literature with similar findings reported in healthy adults and the elderly. OBJECTIVE We aimed to conduct the first, to our knowledge, systematic review of the literature on the evidence for the effects of dopaminergic medications or genetic variations in dopamine transmission on motor recovery or learning after a nonprogressive neurological injury. METHODS A PubMed search was conducted up until April 2018 for all English articles including participants with nonprogressive neurological injury such as cerebral palsy, stroke, spinal cord injury, and traumatic brain injury; quantitative motor outcomes; and assessments of the dopaminergic system or medications. RESULTS The search yielded 237 articles, from which we identified 26 articles meeting all inclusion/exclusion criteria. The vast majority of articles were related to the use of levodopa poststroke; however, several studies assessed the effects of different medications and/or were on individuals with traumatic brain injury, spinal cord injury or cerebral palsy. CONCLUSIONS The evidence suggests that a brain injury can decrease dopamine transmission and that levodopa may have a positive effect on motor outcomes poststroke, although evidence is not conclusive or consistent. Individual variations in genes related to dopamine transmission may also influence the response to motor skill training during neurorehabilitation and the extent to which dopaminergic medications or interventions can augment that response. More rigorous safety and efficacy studies of levodopa and dopaminergic medications in stroke and particularly other neurological injuries including genetic analyses are warranted.
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Jang SH, Chang CH, Jung YJ, Seo YS. Recovery of an injured corticospinal tract via an unusual pathway in a stroke patient: Case report. Medicine (Baltimore) 2019; 98:e14307. [PMID: 30762729 PMCID: PMC6408056 DOI: 10.1097/md.0000000000014307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE A few mechanisms of recovery from an injured corticospinal tract (CST) in stroke patients have been reported: recovery of an injured CST through (1) normal CST pathway, (2) peri-lesional reorganization, and (3) shifting of the cortical origin area of an injured CST from the other areas to the primary motor cortex. However, it has not been clearly elucidated so far. PATIENT CONCERNS A 57-year-old male patient presented with complete weakness of the right extremities due to an intracerebral hemorrhage (ICH) in the left basal ganglia. At three weeks after onset, the patient showed severe weakness of his right upper and lower extremities (Motricity Index [MI]: 28/100, finger extensor: 0/5). At 6 months after onset, his weakness showed some recovery, however, right finger extensor did not show any recovery (MI: 51/100, finger extensor: 0/5). At 9 months after onset, weakness showed significant recovery, particularly right finger extensor (MI: 64/100, right finger extensor: 3/5) and similar motor function persisted until 11 months after onset (MI: 67/100, right finger extensor: 3/5). DIAGNOSES The patient was diagnosed as the right hemiplegia due to ICH in the left corona radiata and basal ganglia. INTERVENTIONS Clinical assessment, transcranial magnetic stimulation (TMS), and diffusion tensor tractography (DTT) were performed at 1, 6, 9, and 11 months after onset. OUTCOMES Discontinuation of the left CST at the midbrain level was observed on 1-month DTT and the corona radiata on 6-month DTT. However, on 9-month DTT, we observed a CST branch originating from the left posterior parietal cortex and then connecting to the main truck to the CST at the thalamic level and thickened on 11-month DTT. On 1-month TMS, no MEP was evoked from the left hemisphere; on 6-month TMS study, MEPs were obtained at a right hand muscle (latency: 22.8 ms, amplitude: 130 μV) and its amplitude was increased as 300 μV with similar latencies on 9- and 11-month TMS studies. LESSONS Recovery of an injured CST via an unusual pathway was demonstrated in a hemiparetic patient with ICH, using DTT and TMS. We believe that our results suggest that precise evaluation for an injured CST using TMS and DTT might be necessary, particularly in young patients, even after 6 months from onset even though the stroke patients show clinical characteristics of severe injury of the affected CST.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, Republic of Korea
| | - You Sung Seo
- Department of Physical Medicine and Rehabilitation
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Affiliation(s)
- David J. Lin
- Center for Neurotechnology and Neurorecovery, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Seth P. Finklestein
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA
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