1
|
Shanks MJ, Byblow WD. Corticomotor pathway function and recovery after stroke: a look back and a way forward. J Physiol 2024. [PMID: 38814805 DOI: 10.1113/jp285562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Stroke is a leading cause of adult disability that results in motor deficits and reduced independence. Regaining independence relies on motor recovery, particularly regaining function of the hand and arm. This review presents evidence from human studies that have used transcranial magnetic stimulation (TMS) to identify neurophysiological mechanisms underlying upper limb motor recovery early after stroke. TMS studies undertaken at the subacute stage after stroke have identified several neurophysiological factors that can drive motor impairment, including membrane excitability, the recruitment of corticomotor neurons, and glutamatergic and GABAergic neurotransmission. However, the inherent variability and subsequent poor reliability of measures derived from motor evoked potentials (MEPs) limit the use of TMS for prognosis at the individual patient level. Currently, prediction tools that provide the most accurate information about upper limb motor outcomes for individual patients early after stroke combine clinical measures with a simple neurophysiological biomarker based on MEP presence or absence, i.e. MEP status. Here, we propose a new compositional framework to examine MEPs across several upper limb muscles within a threshold matrix. The matrix can provide a more comprehensive view of corticomotor function and recovery after stroke by quantifying the evolution of subthreshold and suprathreshold MEPs through compositional analyses. Our contention is that subthreshold responses might be the most sensitive to reduced output of corticomotor neurons, desynchronized firing of the remaining neurons, and myelination processes that occur early after stroke. Quantifying subthreshold responses might provide new insights into post-stroke neurophysiology and improve the accuracy of prediction of upper limb motor outcomes.
Collapse
Affiliation(s)
- Maxine J Shanks
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Winston D Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Ackerley S, Smith MC, Jordan H, Stinear CM. Biomarkers of Motor Outcomes After Stroke. Phys Med Rehabil Clin N Am 2024; 35:259-276. [PMID: 38514217 DOI: 10.1016/j.pmr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Predicting motor outcomes after stroke based on clinical judgment alone is often inaccurate and can lead to inefficient and inequitable allocation of rehabilitation resources. Prediction tools are being developed so that clinicians can make evidence-based, accurate, and reproducible prognoses for individual patients. Biomarkers of corticospinal tract structure and function can improve prediction tool performance, particularly for patients with initially moderate to severe motor impairment. Being able to make accurate predictions for individual patients supports rehabilitation planning and communication with patients and families.
Collapse
Affiliation(s)
- Suzanne Ackerley
- School of Sport and Health Sciences, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand
| | - Harry Jordan
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand
| | - Cathy M Stinear
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand.
| |
Collapse
|
3
|
Wang MH, Wang YX, Xie M, Chen LY, He MF, Lin F, Jiang ZL. Transcutaneous auricular vagus nerve stimulation with task-oriented training improves upper extremity function in patients with subacute stroke: a randomized clinical trial. Front Neurosci 2024; 18:1346634. [PMID: 38525376 PMCID: PMC10957639 DOI: 10.3389/fnins.2024.1346634] [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: 11/29/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Background Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising brain stimulation modality in poststroke upper extremity rehabilitation. Although several studies have examined the safety and reliability of taVNS, the mechanisms underlying motor recovery in stroke patients remain unclear. Objectives This study aimed to investigate the effects of taVNS paired with task-oriented training (TOT) on upper extremity function in patients with subacute stroke and explore the potential underlying mechanisms. Methods In this double-blinded, randomized, controlled pilot trial, 40 patients with subacute stroke were randomly assigned to two groups: the VNS group (VG), receiving taVNS during TOT, and the Sham group (SG), receiving sham taVNS during TOT. The intervention was delivered 5 days per week for 4 weeks. Upper extremity function was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT). Activities of daily living were measured by the modified Barthel Index (MBI). Motor-evoked potentials (MEPs) were measured to evaluate cortical excitability. Assessments were administered at baseline and post-intervention. Additionally, the immediate effect of taVNS was detected using functional near-infrared spectroscopy (fNIRS) and heart rate variability (HRV) before intervention. Results The VG showed significant improvements in upper extremity function (FMA-UE, ARAT) and activities of daily living (MBI) compared to the SG at post-intervention. Furthermore, the VG demonstrated a higher rate of elicited ipsilesional MEPs and a shorter latency of MEPs in the contralesional M1. In the VG, improvements in FMA-UE were significantly associated with reduced latency of contralesional MEPs. Additionally, fNIRS revealed increased activation in the contralesional prefrontal cortex and ipsilesional sensorimotor cortex in the VG in contrast to the SG. However, no significant between-group differences were found in HRV. Conclusion The combination of taVNS with TOT effectively improves upper extremity function in patients with subacute stroke, potentially through modulating the bilateral cortex excitability to facilitate task-specific functional recovery.
Collapse
Affiliation(s)
- Meng-Huan Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi-Xiu Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Xie
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li-Yan Chen
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meng-Fei He
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhong-Li Jiang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
4
|
Hamzei F, Ritter A, Pohl K, Stäps P, Wieduwild E. Different Effect Sizes of Motor Skill Training Combined with Repetitive Transcranial versus Trans-Spinal Magnetic Stimulation in Healthy Subjects. Brain Sci 2024; 14:165. [PMID: 38391739 PMCID: PMC10887384 DOI: 10.3390/brainsci14020165] [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: 12/19/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is used to enhance motor training (MT) performance. The use of rTMS is limited under certain conditions, such as after a stroke with severe damage to the corticospinal tract. This raises the question as to whether repetitive trans-spinal magnetic stimulation (rSMS) can also be used to improve MT. A direct comparison of the effect size between rTMS and rSMS on the same MT is still lacking. Before conducting the study in patients, we determined the effect sizes of different stimulation approaches combined with the same motor training in healthy subjects. Two experiments (E1 and E2) with 96 subjects investigated the effect size of combining magnetic stimulation with the same MT. In E1, high-frequency rTMS, rSMS, and spinal sham stimulation (sham-spinal) were applied once in combination with MT, while one group only received the same MT (without stimulation). In E2, rTMS, rSMS, and sham-spinal were applied in combination with MT over several days. In all subjects, motor tests and motor-evoked potentials were evaluated before and after the intervention period. rTMS had the greatest effect on MT, followed by rSMS and then sham-spinal. Daily stimulation resulted in additional training gains. This study suggests that rSMS increases excitability and also enhances MT performance. This current study provides a basis for further research to discover whether patients who cannot be treated effectively with rTMS would benefit from rSMS.
Collapse
Affiliation(s)
- Farsin Hamzei
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| | - Alexander Ritter
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Kristin Pohl
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| | - Peggy Stäps
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| | - Eric Wieduwild
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| |
Collapse
|
5
|
Park CH, Kim MS. Stratified predictions of upper limb motor outcomes after stroke. Front Neurol 2024; 14:1323529. [PMID: 38239320 PMCID: PMC10794733 DOI: 10.3389/fneur.2023.1323529] [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: 10/18/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Longitudinal observations of upper limb motor recovery after stroke have suggested that certain subgroups may exhibit distinct recovery patterns. Here we sought to examine whether the predictive ability for post-stroke upper limb motor outcomes could be enhanced by applying conventional stratification strategies. Method For 60 individuals who suffered the first stroke, upper limb motor impairment was assessed with the upper extremity Fugl-Meyer assessment (UE-FMA) at 2 weeks as a baseline and then 3 months post-stroke. Brain structural damage at baseline was assessed by MRI data-derived markers ranging from traditional lesion size to the lesion load and to the disconnectome. Linear regression models for predicting upper limb motor outcomes (UE-FMA score at 3 months post-stroke) based on baseline upper limb motor impairment (UE-FMA score at 2 weeks post-stroke), brain structural damage, and their combinations were generated, and those with the best predictive performance were determined for individual subgroups stratified according to initial impairment (severe and non-severe), lesion location (cortical and non-cortical), and neurophysiological status (motor evoked potential-positive and motor evoked potential-negative). Results The best predictions were made by baseline upper limb motor impairment alone for subgroups with less functional impairment (non-severe) or less structural involvement (non-cortical), but by the combination of baseline upper limb motor impairment and brain structural damage for the other subgroups. The predictive models tailored for subgroups determined according to initial impairment and neurophysiological status yielded a smaller overall error than that for the whole group in upper limb motor outcome predictions. Discussion The predictive ability for upper limb motor outcomes could be enhanced beyond the one-size-fits-all model for all individuals with stroke by applying specific stratification strategies, with stratification according to initial impairment being the most promising. We expect that predictive models tailored for individual subgroups could lead closer to the personalized prognosis of upper limb motor outcomes after stroke.
Collapse
Affiliation(s)
- Chang-hyun Park
- Division of Artificial Intelligence and Software, College of Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Su Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| |
Collapse
|
6
|
Antonioni A, Galluccio M, Toselli R, Baroni A, Fregna G, Schincaglia N, Milani G, Cosma M, Ferraresi G, Morelli M, Casetta I, De Vito A, Masiero S, Basaglia N, Malerba P, Severini G, Straudi S. A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures. Clin EEG Neurosci 2023:15500594231209397. [PMID: 37859431 DOI: 10.1177/15500594231209397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background. Stroke is a leading cause of death and disability worldwide and there is a very short period of increased synaptic plasticity, fundamental in motor recovery. Thus, it is crucial to acquire data to guide the rehabilitation treatment. Promising results have been achieved with kinematics and neurophysiological data, but currently, few studies integrate these different modalities. Objectives. We explored the correlations between standardized clinical scales, kinematic data, and EEG measures 4 weeks after stroke. Methods. 26 patients were considered. Among them, 20 patients also performed the EEG study, beyond the kinematic analysis, at 4 weeks. Results. We found correlations between the Fugl-Meyer Assessment-Upper Extremity, movement duration, smoothness measures, and velocity peaks. Moreover, EEG measures showed a tendency for the healthy hemisphere to vicariate the affected one in patients characterized by better clinical conditions. Conclusions. These results suggest the relevance of kinematic (in particular movement duration and smoothness) and EEG biomarkers to evaluate post-stroke recovery. We emphasize the importance of integrating clinical data with kinematic and EEG analyses from the early stroke stages, in order to guide rehabilitation strategies to best leverage the short period of increased synaptic plasticity.
Collapse
Affiliation(s)
- Annibale Antonioni
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, Ferrara, Italy
| | - Martina Galluccio
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Riccardo Toselli
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Padua, Italy
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Giulia Fregna
- Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, Ferrara, Italy
| | - Nicola Schincaglia
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Giada Milani
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Michela Cosma
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Giovanni Ferraresi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Monica Morelli
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Ilaria Casetta
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Padua, Italy
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
| | - Paola Malerba
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- School of Medicine, The Ohio State University, Columbus, OH, USA
| | - Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dulin, Ireland
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| |
Collapse
|
7
|
Williamson JN, James SA, He D, Li S, Sidorov EV, Yang Y. High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study. Front Hum Neurosci 2023; 17:1286238. [PMID: 37900725 PMCID: PMC10602806 DOI: 10.3389/fnhum.2023.1286238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Previous studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation protocol that facilitates the lesioned CST and inhibits the contralesional CRST to improve upper extremity rehabilitation in individuals with moderate-to-severe motor impairments post-stroke. Methods Fourteen individuals (minimum 3 months post ischemic stroke) consented. Physician decision of the participants baseline assessment qualified eight to continue in a randomized, double-blind cross-over pilot trial (ClinicalTrials.gov Identifier: NCT05174949) with: (1) anodal high-definition transcranial direct stimulation (HD-tDCS) over the ipsilesional primary motor cortex (M1), (2) cathodal HD-tDCS over contralesional dorsal premotor cortex (PMd), (3) sham stimulation, with a two-week washout period in-between. Subject-specific MR images and computer simulation were used to guide HD-tDCS and verified by Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP). The motor behavior outcome was evaluated by an Fugl-Meyer Upper Extremity score (primary outcome measure) and the excitability of the ipslesoinal CST and contralesional CRST was determined by the change of MEP latencies and amplitude (secondary outcome measures). Results The baseline ipsilesional M1 MEP latency and amplitude were correlated with FM-UE. FM-UE scores were improved post HD-tDCS, in comparison to sham stimulation. Both anodal and cathodal HD-tDCS reduced the latency of the ipsilesional M1 MEP. The contralesional PMd MEP disappeared/delayed after HD-tDCS. Discussion These results suggest that HD-tDCS could improve the function of the lesioned corticospinal tract and reduce the excitability of the contralesional cortico-reticulospinal tract, thus, improving motor function of the upper extremity in more severely impaired individuals.
Collapse
Affiliation(s)
- Jordan N. Williamson
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Shirley A. James
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, OK, United States
| | - Dorothy He
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, UT Health Huston, McGovern Medical School, Houston, TX, United States
| | - Evgeny V. Sidorov
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yuan Yang
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Clinical Imaging Research Center, Stephenson Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Gallogly College of Engineering, Stephenson School of Biomedical Engineering, University of Oklahoma, Oklahoma City, OK, United States
| |
Collapse
|
8
|
Szymankiewicz-Szukała A, Huber J, Czarnecki P, Wiertel-Krawczuk A, Dąbrowski M. Temporary Occlusion of Common Carotid Arteries Does Not Evoke Total Inhibition in the Activity of Corticospinal Tract Neurons in Experimental Conditions. Biomedicines 2023; 11:biomedicines11051287. [PMID: 37238958 DOI: 10.3390/biomedicines11051287] [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: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Temporary occlusion of the common cervical artery is the reason for ischemic stroke in 25% of patients. Little data is provided on its effects, especially regarding neurophysiological studies verifying the neural efferent transmission within fibers of the corticospinal tract in experimental conditions. Studies were performed on 42 male Wistar rats. In 10 rats, ischemic stroke was evoked by permanent occlusion of the right carotid artery (group A); in 11 rats, by its permanent bilateral occlusion (B); in 10 rats, by unilateral occlusion and releasing after 5 min (C); and in 11 rats, by bilateral occlusion and releasing after 5 min (D). Efferent transmission of the corticospinal tract was verified by motor evoked potential (MEP) recordings from the sciatic nerve after transcranial magnetic stimulation. MEPs amplitude and latency parameters, oral measurements of temperature, and verification of ischemic effects in brain slides stained with hematoxylin and eosin staining (H + E) were analyzed. In all groups of animals, the results showed that five minutes of uni- or bilateral occlusion of the common carotid artery led to alterations in brain blood circulation and evoked changes in MEP amplitude (by 23.2% on average) and latency parameters (by 0.7 ms on average), reflecting the partial inability of tract fibers to transmit neural impulses. These abnormalities were associated with a significant drop in the body temperature by 1.5 °C on average. Ten minutes occlusion in animals from groups A and B resulted in an MEP amplitude decrease by 41.6%, latency increase by 0.9 ms, and temperature decrease by 2.9 °C of the initial value. In animals from groups C and D, five minutes of recovery of arterial blood flow evoked stabilization of the MEP amplitude by 23.4%, latency by 0.5 ms, and temperature by 0.8 °C of the initial value. In histological studies, the results showed that ischemia was most prominent bilaterally in sensory and motor areas, mainly for the forelimb, rather than the hindlimb, innervation of the cortex, putamen and caudate nuclei, globulus pallidus, and areas adjacent to the fornix of the third ventricle. We found that the MEP amplitude parameter is more sensitive than the latency and temperature variability in monitoring the ischemia effects course following common carotid artery infarction, although all parameters are correlated with each other. Temporary five-minute lasting occlusion of common carotid arteries does not evoke total and permanent inhibition in the activity of corticospinal tract neurons in experimental conditions. The symptoms of rat brain infarction are much more optimistic than those described in patients after stroke, and require further comparison with the clinical observations.
Collapse
Affiliation(s)
- Agnieszka Szymankiewicz-Szukała
- Department Pathophysiology of Locomotor Organs, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznań, Poland
| | - Juliusz Huber
- Department Pathophysiology of Locomotor Organs, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznań, Poland
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznań, Poland
| | - Agnieszka Wiertel-Krawczuk
- Department Pathophysiology of Locomotor Organs, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznań, Poland
| | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznań, Poland
| |
Collapse
|
9
|
Zhang JJ, Sánchez Vidaña DI, Chan JNM, Hui ESK, Lau KK, Wang X, Lau BWM, Fong KNK. Biomarkers for prognostic functional recovery poststroke: A narrative review. Front Cell Dev Biol 2023; 10:1062807. [PMID: 36699006 PMCID: PMC9868572 DOI: 10.3389/fcell.2022.1062807] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background and objective: Prediction of poststroke recovery can be expressed by prognostic biomarkers that are related to the pathophysiology of stroke at the cellular and molecular level as well as to the brain structural and functional reserve after stroke at the systems neuroscience level. This study aimed to review potential biomarkers that can predict poststroke functional recovery. Methods: A narrative review was conducted to qualitatively summarize the current evidence on biomarkers used to predict poststroke functional recovery. Results: Neurophysiological measurements and neuroimaging of the brain and a wide diversity of molecules had been used as prognostic biomarkers to predict stroke recovery. Neurophysiological studies using resting-state electroencephalography (EEG) revealed an interhemispheric asymmetry, driven by an increase in low-frequency oscillation and a decrease in high-frequency oscillation in the ipsilesional hemisphere relative to the contralesional side, which was indicative of individual recovery potential. The magnitude of somatosensory evoked potentials and event-related desynchronization elicited by movement in task-related EEG was positively associated with the quantity of recovery. Besides, transcranial magnetic stimulation (TMS) studies revealed the potential values of using motor-evoked potentials (MEP) and TMS-evoked EEG potentials from the ipsilesional motor cortex as prognostic biomarkers. Brain structures measured using magnetic resonance imaging (MRI) have been implicated in stroke outcome prediction. Specifically, the damage to the corticospinal tract (CST) and anatomical motor connections disrupted by stroke lesion predicted motor recovery. In addition, a wide variety of molecular, genetic, and epigenetic biomarkers, including hemostasis, inflammation, tissue remodeling, apoptosis, oxidative stress, infection, metabolism, brain-derived, neuroendocrine, and cardiac biomarkers, etc., were associated with poor functional outcomes after stroke. However, challenges such as mixed evidence and analytical concerns such as specificity and sensitivity have to be addressed before including molecular biomarkers in routine clinical practice. Conclusion: Potential biomarkers with prognostic values for the prediction of functional recovery after stroke have been identified; however, a multimodal approach of biomarkers for prognostic prediction has rarely been studied in the literature. Future studies may incorporate a combination of multiple biomarkers from big data and develop algorithms using data mining methods to predict the recovery potential of patients after stroke in a more precise way.
Collapse
Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Jackie Ngai-Man Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Edward S. K. Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Benson W. M. Lau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| |
Collapse
|
10
|
Motolese F, Lanzone J, Todisco A, Rossi M, Santoro F, Cruciani A, Capone F, Di Lazzaro V, Pilato F. The role of neurophysiological tools in the evaluation of ischemic stroke evolution: a narrative review. Front Neurol 2023; 14:1178408. [PMID: 37181549 PMCID: PMC10172480 DOI: 10.3389/fneur.2023.1178408] [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: 03/02/2023] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
Ischemic stroke is characterized by a complex cascade of events starting from vessel occlusion. The term "penumbra" denotes the area of severely hypo-perfused brain tissue surrounding the ischemic core that can be potentially recovered if blood flow is reestablished. From the neurophysiological perspective, there are local alterations-reflecting the loss of function of the core and the penumbra-and widespread changes in neural networks functioning, since structural and functional connectivity is disrupted. These dynamic changes are closely related to blood flow in the affected area. However, the pathological process of stroke does not end after the acute phase, but it determines a long-term cascade of events, including changes of cortical excitability, that are quite precocious and might precede clinical evolution. Neurophysiological tools-such as Transcranial Magnetic Stimulation (TMS) or Electroencephalography (EEG)-have enough time resolution to efficiently reflect the pathological changes occurring after stroke. Even if they do not have a role in acute stroke management, EEG and TMS might be helpful for monitoring ischemia evolution-also in the sub-acute and chronic stages. The present review aims to describe the changes occurring in the infarcted area after stroke from the neurophysiological perspective, starting from the acute to the chronic phase.
Collapse
Affiliation(s)
- Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- *Correspondence: Francesco Motolese,
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Milan, Italy
| | - Antonio Todisco
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Mariagrazia Rossi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Santoro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessandro Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| |
Collapse
|
11
|
Jitsakulchaidej P, Wivatvongvana P, Kitisak K. Normal parameters for diagnostic transcranial magnetic stimulation using a parabolic coil with biphasic pulse stimulation. BMC Neurol 2022; 22:510. [PMID: 36585660 PMCID: PMC9805266 DOI: 10.1186/s12883-022-02977-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/10/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND TMS is being used to aid in the diagnosis of central nervous system (CNS) illnesses. It is useful in planning rehabilitation programs and setting appropriate goals for patients. We used a parabolic coil with biphasic pulse stimulation to find normal values for diagnostic TMS parameters. OBJECTIVES 1. To determine the normal motor threshold (MT), motor evoked potentials (MEP), central motor conduction time (CMCT), intracortical facilitation (ICF), short-interval intracortical inhibition (SICI), and silent period (SP) values. 2. To measure the MEP latencies of abductor pollicis brevis (APB) and extensor digitorum brevis (EDB) at various ages, heights, and arm and leg lengths. STUDY DESIGN Descriptive Study. SETTING Department of Rehabilitation Medicine, Chiang Mai University, Thailand. SUBJECTS Forty-eight healthy participants volunteered for the study. METHODS All participants received a single diagnostic TMS using a parabolic coil with biphasic pulse stimulation on the left primary motor cortex (M1). All parameters: MT, MEP, CMCT, ICF, SICI, and SP were recorded through surface EMGs at the right APB and EDB. Outcome parameters were reported by the mean and standard deviation (SD) or median and interquartile range (IQR), according to data distribution. MEP latencies of APB and EDB were also measured at various ages, heights, and arm and leg lengths. RESULTS APB-MEP latencies at 120% and 140% MT were 21.77 ± 1.47 and 21.17 ± 1.44 ms. APB-CMCT at 120% and 140% MT were 7.81 ± 1.32 and 7.19 ± 1.21 ms. APB-MEP amplitudes at 120% and 140% MT were 1.04 (0.80-1.68) and 2.24 (1.47-3.52) mV. EDB-MEP latencies at 120% and 140% MT were 37.14 ± 2.85 and 36.46 ± 2.53 ms. EDB-CMCT at 120% and 140% MT were 14.33 ± 2.50 and 13.63 ± 2.57 ms. EDB-MEP amplitudes at 120% and 140% MT were 0.60 (0.38-0.98) and 0.95 (0.69-1.55) mV. ICF amplitudes of APB and EDB were 2.26 (1.61-3.49) and 1.26 (0.88-1.98) mV. SICI amplitudes of APB and EDB were 0.21 (0.13-0.51) and 0.18 (0.09-0.29) mV. MEP latencies of APB at 120% and 140% MT were different between heights < 160 cm and ≥ 160 cm (p < 0.001 and p < 0.001) and different between arm lengths < 65 and ≥ 65 cm (p = 0.022 and p = 0.002). CONCLUSION We established diagnostic TMS measurements using a parabolic coil with a biphasic pulse configuration. EDB has a higher MT than APB. The 140/120 MEP ratio of APB and EDB is two-fold. The optimal MEP recording for APB is 120%, whereas EDB is 140% of MT. CMCT by the F-wave is more convenient and tolerable for patients. ICF provides a twofold increase in MEP amplitude. SICI provides a ¼-fold of MEP amplitude. SP from APB and EDB are 121.58 ± 21.50 and 181.01 ± 40.99 ms, respectively. Height and MEP latencies have a modest relationship, whereas height and arm length share a strong positive correlation.
Collapse
Affiliation(s)
- Pimthong Jitsakulchaidej
- grid.7132.70000 0000 9039 7662Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Pakorn Wivatvongvana
- grid.7132.70000 0000 9039 7662Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Kittipong Kitisak
- grid.7132.70000 0000 9039 7662Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| |
Collapse
|
12
|
Milani G, Antonioni A, Baroni A, Malerba P, Straudi S. Relation Between EEG Measures and Upper Limb Motor Recovery in Stroke Patients: A Scoping Review. Brain Topogr 2022; 35:651-666. [PMID: 36136166 DOI: 10.1007/s10548-022-00915-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022]
Abstract
Current clinical practice does not leverage electroencephalography (EEG) measurements in stroke patients, despite its potential to contribute to post-stroke recovery predictions. We review the literature on the effectiveness of various quantitative and qualitative EEG-based measures after stroke as a tool to predict upper limb motor outcome, in relation to stroke timeframe and applied experimental tasks. Moreover, we aim to provide guidance on the use of EEG in the assessment of upper limb motor recovery after stroke, suggesting a high potential for some metrics in the appropriate context. We identified relevant papers (N = 16) from databases ScienceDirect, Web of Science and MEDLINE, and assessed their methodological quality with the Joanna Briggs Institute (JBI) Critical Appraisal. We applied the Preferred Reporting Systems for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Framework. Identified works used EEG to identify properties including event-related activation, spectral power in physiologically relevant bands, symmetry in brain dynamics, functional connectivity, cortico-muscular coherence and rhythmic coordination. EEG was acquired in resting state or in relation to behavioural conditions. Motor outcome was mainly evaluated with the Upper Limb Fugl-Meyer Assessment. Despite great variability in the literature, data suggests that the most promising EEG quantifiers for predicting post-stroke motor outcome are event-related measures. Measures of spectral power in physiologically relevant bands and measures of brain symmetry also show promise. We suggest that EEG measures may improve our understanding of stroke brain dynamics during recovery, and contribute to establishing a functional prognosis and choosing the rehabilitation approach.
Collapse
Affiliation(s)
- Giada Milani
- IIT@Unife Center for Translational Neurophysiology, Istituto Italiano di Tecnologia, Ferrara, Italy.,Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Annibale Antonioni
- Unit of Clinical Neurology, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Paola Malerba
- Battelle Center for Mathematical Medicine and Center for Biobehavioral Health, The Ohio State University, Columbus, OH, USA
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy. .,Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
| |
Collapse
|
13
|
Xing Y, Zhang Y, Li C, Luo L, Hua Y, Hu J, Bai Y. Repetitive Transcranial Magnetic Stimulation of the Brain After Ischemic Stroke: Mechanisms from Animal Models. Cell Mol Neurobiol 2022; 43:1487-1497. [PMID: 35917043 DOI: 10.1007/s10571-022-01264-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
Stroke is a common cerebrovascular disease with high morbidity, mortality, and disability worldwide. Post-stroke dysfunction is related to the death of neurons and impairment of synaptic structure, which results from cerebral ischemic damage. Currently, transcranial magnetic stimulation (TMS) techniques are available to provide clinically effective interventions and quantitative diagnostic and prognostic biomarkers. The development of TMS has been 40 years and a range of repetitive TMS (rTMS) protocols are now available to regulate neuronal plasticity in many neurological disorders, such as stroke, Parkinson disease, psychiatric disorders, Alzheimer disease, and so on. Basic studies in an animal model with ischemic stroke are significant for demonstrating potential mechanisms of neural restoration induced by rTMS. In this review, the mechanisms were summarized, involving synaptic plasticity, neural cell death, neurogenesis, immune response, and blood-brain barrier (BBB) disruption in vitro and vivo experiments with ischemic stroke models. Those findings can contribute to the understanding of how rTMS modulated function recovery and the exploration of novel therapeutic targets. The mechanisms of rTMS in treating ischemic stroke from animal models. rTMS can prompt synaptic plasticity by increasing NMDAR, AMPAR and BDNF expression; rTMS can inhibit pro-inflammatory cytokines TNF and facilitate the expression of anti-inflammatory cytokines IL-10 by shifting astrocytic phenotypes from A1 to A2, and shifting microglial phenotypes from M1 to M2; rTMS facilitated the release of angiogenesis-related factors TGFβ and VEGF in A2 astrocytes, which can contribute to vasculogenesis and angiogenesis; rTMS can suppress apoptosis by increasing Bcl-2 expression and inhibiting Bax, caspase-3 expression; rTMS can also suppress pyroptosis by decreasing caspase-1, IL-1β, ASC, GSDMD and NLRP1 expression. rTMS, repetitive transcranial magnetic stimulation; NMDAR, N-methyl-D-aspartic acid receptors; AMPAR: α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors; BDNF, brain-derived neurotrophic factor; VEGF, vascular endothelial growth factor; GSDMD: cleaved Caspase-1 cleaves Gasdermin D; CBF: cerebral blood flow.
Collapse
Affiliation(s)
- Ying Xing
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Congqin Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Lu Luo
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
| |
Collapse
|
14
|
Dimyan MA, Harcum S, Ermer E, Boos AF, Conroy SS, Liu F, Horn LB, Xu H, Zhan M, Chen H, Whitall J, Wittenberg GF. Baseline Predictors of Response to Repetitive Task Practice in Chronic Stroke. Neurorehabil Neural Repair 2022; 36:426-436. [PMID: 35616437 DOI: 10.1177/15459683221095171] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repetitive task practice reduces mean upper extremity motor impairment in populations of patients with chronic stroke, but individual response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish realistic rehabilitation goals and to effectively allocate resources. OBJECTIVES To identify prognostic factors and better understand the biological substrate for reductions in arm impairment in response to repetitive task practice among patients with chronic (≥6 months) post-stroke hemiparesis. METHODS The intervention is a form of repetitive task practice using a combination of robot-assisted therapy and functional arm use in real-world tasks. Baseline measures include the Fugl-Meyer Assessment, Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, MRI, transcranial magnetic stimulation, kinematics, accelerometry, and genomic testing. RESULTS Mean increase in FM-UE was 4.6 ± 1.0 SE, median 2.5. Approximately one-third of participants had a clinically meaningful response to the intervention, defined as an increase in FM ≥ 5. The selected logistic regression model had a receiver operating curve with AUC = .988 (Std Error = .011, 95% Wald confidence limits: .967-1) showed little evidence of overfitting. Six variables that predicted response represented impairment, functional, and genomic measures. CONCLUSION A simple weighted sum of 6 baseline factors can accurately predict clinically meaningful impairment reduction after outpatient intensive practice intervention in chronic stroke. Reduction of impairment may be a critical first step to functional improvement. Further validation and generalization of this model will increase its utility in clinical decision-making.
Collapse
Affiliation(s)
- Michael A Dimyan
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research, Education and Clinical Center and Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stacey Harcum
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Elsa Ermer
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amy F Boos
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan S Conroy
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Fang Liu
- Rehab & Neural Engineering Labs, Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda B Horn
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Huichun Xu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hegang Chen
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - George F Wittenberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research, Education and Clinical Center and Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research, Education and Clinical Center, Human Engineering Research Laboratory, VA Maryland Health Care System, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Yu-Lei X, Shan W, Ju Y, Yu-Han X, Wu Q, Yin-Xu W. Theta burst stimulation versus high-frequency repetitive transcranial magnetic stimulation for poststroke dysphagia: A randomized, double-blind, controlled trial. Medicine (Baltimore) 2022; 101:e28576. [PMID: 35029231 PMCID: PMC8758019 DOI: 10.1097/md.0000000000028576] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) of high-frequency (10 Hz) on suprahyoid motor cortex has been an evidence-based treatment for poststroke dysphagia. Intermittent theta burst stimulation (iTBS) can be performed in 3 minutes compared with 20 ± 5 minutes for 10 Hz rTMS. This study aimed to ensure the clinical efficacy, safety, and tolerability of iTBS compared with 10 Hz rTMS for patients with poststroke dysphagia. METHOD In this randomized, double-blind, single-center, controlled trial, 47 participants were randomly assigned to iTBS (n = 24) and rTMS (n = 23) group. Each participant received iTBS or rTMS daily at suprahyoid motor cortex of affected hemisphere for 10 consecutive days. The outcomes were assessed at baseline, immediately, and 2 weeks after intervention, including water-swallowing test, standardized swallowing assessment, Mann assessment of swallowing ability, Murray Secretion Scale, Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and motor evoked potential (MEP) of bilateral suprahyoid muscle. RESULTS There were no significant differences between groups. There was a significant improvement on all rating scales and MEP after rTMS and iTBS. No significant differences on water-swallowing test, Mann assessment of swallowing ability, standardized swallowing assessment, Murray Secretion Scale scores, and MEP were observed between groups. In particular, there was significant differences on Penetration-Aspiration Scale scores (viscous liquid: mean difference = 1.016; 95% CI: 0.32-1.71; effect size: 0.360; P = .005) and the residue rate of pyriform fossa (viscous liquid: mean difference = 0.732; 95% CI: 0.18-1.28; effect size: 0.248; P = .010) in between-group. Comparing the differences over the changes of all rating scales, only the residue rate of epiglottis valley between groups was found to be significantly different (dilute liquid: mean difference = -0.567; 95% CI: -0.98 to -0.15; P = .009). There was no severe adverse effect and high dropout rates in both groups. CONCLUSION The clinical efficacy, safety, and tolerability of iTBS showed non-inferior to 10 Hz rTMS for patients with poststroke dysphagia. The present study can be used to improve the clinicians' knowledge and clinical decision skills on iTBS and rTMS for poststroke dysphagia.
Collapse
Affiliation(s)
- Xie Yu-Lei
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Wang Shan
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Yang Ju
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Xie Yu-Han
- University of South China, Hengyang City, Hunan Province, China
| | - Qing Wu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Wang Yin-Xu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| |
Collapse
|
16
|
Srivastava A, Kumar P, Prasad M, Das A, Vibha D, Garg A, Goyal V. Utility of transcranial magnetic stimulation and diffusion tensor imaging for prediction of upper-limb motor recovery in acute ischemic stroke patients. Ann Indian Acad Neurol 2022; 25:54-59. [PMID: 35342270 PMCID: PMC8954333 DOI: 10.4103/aian.aian_254_21] [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] [Received: 03/25/2021] [Revised: 05/15/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The recovery of the upper-limb (UL) motor function after ischemic stroke (IS) remains a major scientific, clinical, and patient concern and it is hard to predict alone from the clinical symptoms. Objective: To determine the accuracy of the prediction of the recovery of UL motor function in patients with acute ischemic middle cerebral artery (MCA) stroke using individual clinical, transcranial magnetic stimulation (TMS) or diffusion tensor imaging (DTI) parameters or their combination. Methods and Material: The first-ever acute ischemic MCA stroke patients within 7 days of the stroke onset who had an obvious UL motor deficit underwent TMS for the presence of motor-evoked potential (MEP) and DTI to evaluate the integrity of corticospinal tracts. Multivariate logistic regression analysis was done to test for the accuracy of the prediction of the recovery of UL motor function. Results: Twenty-nine acute ischemic MCA stroke patients (21 males and 8 females) with a mean age of 51.45 ± 14.26 years were recruited. Model-I included clinical scales (Fugl-Meyer Assessment [FMA] + Motricity Index [MI]) + TMS (MEP) + DTI (fractional anisotropy [FA]) were found to be the most accurate predictive model, with the overall predictive ability (93.3%; 95% confidence interval [CI]: 0.87–0.99) and sensitivity: 94.9% (95% CI: 0.87–1.0) and specificity: 95.8% (95% CI: 0.89–1.0); respectively. Conclusion: The accuracy of UL motor recovery can be predicted through the clinical battery and their elements as well as TMS (MEP) and DTI (FA) parameters. Further, well-designed prospective studies are needed to confirm our findings.
Collapse
|
17
|
Jang SH, Lee J, Kim JW, Choi KT. Prognosis prediction of motor outcome in hemiparetic patients with anterior choroidal artery infarction: Radiologic and transcranial magnetic stimulation prognostic validation studies (STROBE). Medicine (Baltimore) 2021; 100:e28397. [PMID: 34941175 PMCID: PMC8702112 DOI: 10.1097/md.0000000000028397] [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: 07/15/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT To investigate prognosis prediction of motor outcome in anterior choroidal artery (AChA) infarction patients using radiologic and transcranial magnetic stimulation (TMS) studies.Twenty six patients with complete weakness of the affected hand were recruited. The Motricity Index (MI), Medical Research Council (MRC) scores for the affected finger extensors, Modified Brunnstrom classification (MBC) and Functional Ambulation Category (FAC) were evaluated twice: at onset and the chronic stage (3-4 months after onset). Patients were assigned according to the presence of infarction at the corona radiata (CR); the CR-positive group (infarct presence at the CR and posterior limb of internal capsule [PLIC], 11 patients) and CR-negative group (infarct presence at the PLIC, 15 patients), and the presence of motor evoked potentials at the affected hand muscle: the TMS-positive group (11 patients) and the TMS-negative group (15 patients).At the second evaluation, the MI scores were significantly different between the CR-positive (45.10 ± 7.06) and CR-negative groups (57.90 ± 11.56), and between the TMS-positive (60.37 ± 11.53) and TMS-negative groups (46.70 ± 7.99) (P < .05). The MRC scores for the finger extensors were also significantly different between the CR-positive (0.95 ± 1.01) and CR-negative (2.57 ± 1.33) groups and between the TMS-positive (3.05 ± 0.88) and TMS-negative (1.03 ± 1.14) groups (P < .05). Fourteen (53.85%) of the 26 patients recovered to have a functional hand score (MBC ≥5) and 19 (73.07%) of the 26 patients recovered to have an independent gait score (FAC ≥3) on their second evaluation.The results show that CR involvement in addition to the presence of a PLIC lesion and a TMS-negative response were related to poor motor outcomes in patients with an AChA infarction. Consequently, radiologic and TMS studies can be considered for motor outcome prognosis prediction in patients with an AChA infarction.
Collapse
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Jun Lee
- Department of Neurology, College of Medicine, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Jae Woon Kim
- Department of Radiology, College of Medicine, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Kyu Tae Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| |
Collapse
|
18
|
Karatzetzou S, Tsiptsios D, Terzoudi A, Aggeloussis N, Vadikolias K. Transcranial magnetic stimulation implementation on stroke prognosis. Neurol Sci 2021; 43:873-888. [PMID: 34846585 DOI: 10.1007/s10072-021-05791-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/25/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Stroke represents a major cause of functional disability with increasing prevalence. Thus, it is imperative that stroke prognosis be both timely and valid. Up to today, several biomarkers have been investigated in an attempt to forecast stroke survivors' potential for motor recovery, transcranial magnetic stimulation (TMS) being among them. METHODS A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1990 and 2021 that focused on the potential utility of TMS implementation on stroke prognosis. Only full-text articles published in the English language were included. RESULTS Thirty-nine articles have been traced and included in this review. DISCUSSION Motor evoked potentials (MEPs) recording is indicative of a favorable prognosis concerning the motor recovery of upper and lower extremities' weakness, swallowing and speech difficulties, and the patient's general functional outcome. On the contrary, MEP absence is usually associated with poor prognosis. Relative correlations have also been made among other TMS variants (motor threshold, MEP amplitude, central motor conduction time) and the expected recovery rate. Overall, TMS represents a non-invasive, fast, safe, and reproducible prognostic tool poststroke that could resolve prognostic uncertainties in cases of stroke.
Collapse
Affiliation(s)
- Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece. .,Laboratory of Clinical Neurophysiology, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Aikaterini Terzoudi
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Clinical Neurophysiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Aggeloussis
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Clinical Neurophysiology, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
19
|
Fekete K, Tóth J, Horváth L, Márton S, Héja M, Csiba L, Árokszállási T, Bagoly Z, Sulina D, Fekete I. Neurophysiological Examinations as Adjunctive Tool to Imaging Techniques in Spontaneous Intracerebral Hemorrhage: IRONHEART Study. Front Neurol 2021; 12:757078. [PMID: 34777228 PMCID: PMC8578792 DOI: 10.3389/fneur.2021.757078] [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: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Intracerebral hemorrhage (ICH) is a devastating disease, which may lead to severe disability or even death. Although many factors may influence the outcome, neurophysiological examinations might also play a role in its course. Our aim was to examine whether the findings of electroencephalography (EEG) and transcranial magnetic stimulation (TMS) can predict the prognosis of these patients. Methods: Between June 1 2017 and June 15 2021, 116 consecutive patients with ICH were enrolled prospectively in our observational study. Clinical examinations and non-Contrast computed tomography (NCCT) scan were done on admission for ICH; follow-up NCCT scans were taken at 14 ± 2 days and at 3 months ± 7 days after stroke onset. EEG and TMS examinations were also carried out. Results: Of the patients in the study, 65.5% were male, and the mean age of the study population was 70 years. Most patients had a history of hypertension, 50.8% of whom had been untreated. In almost 20% of the cases, excessive hypertension was measured on admission, accompanied with >10 mmol/L blood glucose level, whereas their Glasgow Coma Scale was 12 on average. Presence of blood in the ventricles or subarachnoid space and high blood and perihematomal volumes meant poor prognosis. Pathological EEG was prognostic of a worse outcome. With TMS examination at 14 days, it might be possible to estimate outcome in a univariate model and the absence, or reduction of the amplitude of the motor evoked potentials was associated with poor prognosis. Conclusion: Together with the clinical symptoms, the volume of bleeding, perihematomal edema (or their combined volume), and neurophysiological examinations like EEG and TMS play an important role in the neurological outcome of patients with ICH. This might affect the patients' rehabilitation plans in the future, since with the help of the examinations the subset of patients with potential for recovery could be identified.
Collapse
Affiliation(s)
- Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Tóth
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Horváth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Sándor Márton
- Institute of Political Science and Sociology, Faculty of Arts, University of Debrecen, Debrecen, Hungary
| | - Máté Héja
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, University of Debrecen, Debrecen, Hungary
| | - Tamás Árokszállási
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Bagoly
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, University of Debrecen, Debrecen, Hungary.,Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Sulina
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
20
|
Guder S, Frey BM, Backhaus W, Braass H, Timmermann JE, Gerloff C, Schulz R. The Influence of Cortico-Cerebellar Structural Connectivity on Cortical Excitability in Chronic Stroke. Cereb Cortex 2021; 30:1330-1344. [PMID: 31647536 DOI: 10.1093/cercor/bhz169] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/17/2019] [Accepted: 06/22/2019] [Indexed: 12/11/2022] Open
Abstract
Brain imaging has recently evidenced that the structural state of distinct reciprocal cortico-cerebellar fiber tracts, the dentato-thalamo-cortical tract (DTCT), and the cortico-ponto-cerebellar tract (CPCeT), significantly influences residual motor output in chronic stroke patients, independent from the level of damage to the corticospinal tract (CST). Whether such structural information might also directly relate to measures of cortical excitability is an open question. Eighteen chronic stroke patients with supratentorial ischemic lesions and 17 healthy controls underwent transcranial magnetic stimulation to assess recruitment curves of motor evoked potentials of both hemispheres. Diffusion-weighted imaging and probabilistic tractography were applied to reconstruct reciprocal cortico-cerebellar motor tracts between the primary motor cortex and the cerebellum. Tract-related microstructure was estimated by means of fractional anisotropy, and linear regression modeling was used to relate it to cortical excitability. The main finding was a significant association between cortical excitability and the structural integrity of the DTCT, the main cerebellar outflow tract, independent from the level of damage to the CST. A comparable relationship was neither detectable for the CPCeT nor for the healthy controls. This finding contributes to a mechanistic understanding of the putative supportive role of the cerebellum for residual motor output by facilitating cortical excitability after stroke.
Collapse
Affiliation(s)
- Stephanie Guder
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Hanna Braass
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jan E Timmermann
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|
21
|
Cleland BT, Sisel E, Madhavan S. Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke. Exp Brain Res 2021; 239:2251-2260. [PMID: 34059935 DOI: 10.1007/s00221-021-06144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb. We hypothesized that: (1) onset latency would be longer for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb, and (2) duration would be shorter for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb. Data were collected as a part of a pre-test of a randomized controlled trial. TMS was applied to the ipsilateral and contralateral hemisphere of the paretic and non-paretic limb. MEP onset latency and duration were calculated from the tibialis anterior. Thirty-five participants with chronic stroke were included in the final analysis. Onset latency was longer in the paretic than the non-paretic limb (~ 6.0 ms) and longer after ipsilateral than contralateral stimulation (~ 1.8 ms). Duration was longer in the paretic than the non-paretic limb (~ 9.2 ms) and longer after contralateral than ipsilateral stimulation (~ 5.2 ms). Ipsilateral MEPs may be elicited through ipsilateral pathways with fewer fibers with a higher activation threshold and/or greater spinal branching. MEPs from the paretic limb may reflect slower central motor conduction, peripheral changes, or changes in motor pathway.
Collapse
Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA
| | - Emily Sisel
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
| |
Collapse
|
22
|
Okamoto Y, Ishii D, Yamamoto S, Ishibashi K, Wakatabi M, Kohno Y, Numata K. Relationship Between Motor Function, DTI, and Neurophysiological Parameters in Patients with Stroke in the Recovery Rehabilitation unit. J Stroke Cerebrovasc Dis 2021; 30:105889. [PMID: 34062310 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/08/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES We investigated the relationship between pyramidal tract evaluation indexes (i.e., diffusion tensor imaging, transcranial magnetic stimulation (TMS)-induced motor-evoked potential (MEP), and central motor conduction time (CMCT) on admission to the recovery rehabilitation unit) and motor functions at discharge in patients with ischemic or hemorrhagic stroke. MATERIALS AND METHODS Seventeen patients were recruited (12 men; 57.9 ± 10.3 years). The mean fractional anisotropy (FA) values of the right and left posterior limbs of the internal capsule were estimated using a computer-automated method. We determined the ratios of FA values in the affected and unaffected hemispheres (rFA), TMS-induced MEP, and the ratios of CMCT in the affected and unaffected hemispheres (rCMCT) and examined their association with motor functions (Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT)) at discharge. RESULTS Higher rFA values of the posterior limb of the internal capsule on admission to the recovery rehabilitation unit led to a better recovery of upper limb function (FMA: r = 0.78, p < 0.001; ARAT: r = 0.74, p = 0.001). Patients without MEP had poorer recovery of upper limb function than those with MEP (FMA: p < 0.001; ARAT: p = 0.001). The higher the rCMCT, the poorer the recovery of upper limb function (ARAT: r = -0.93, p < 0.001). However, no association was observed between the pyramidal tract evaluation indexes and recovery of lower limb motor function. CONCLUSIONS Evaluating the pyramidal tract is useful for predicting upper limb function prognosis, but not for lower limb function prognosis.
Collapse
Affiliation(s)
- Yoshitaka Okamoto
- Department of Rehabilitation, University of Tsukuba Hospital, 2-1-2, Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Daisuke Ishii
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan; Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chiba 260-8670, Japan.
| | - Satoshi Yamamoto
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Kiyoshige Ishibashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Masahiro Wakatabi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Kenji Numata
- Department of Physical Therapy, Tokyo Professional University of Health Sciences, 2-22-10 Shiohama, Koto-ku, Tokyo 135-0043, Japan
| |
Collapse
|
23
|
Singh N, Saini M, Kumar N, Srivastava MVP, Mehndiratta A. Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:76. [PMID: 33957937 PMCID: PMC8101163 DOI: 10.1186/s12984-021-00867-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training sessions with dose-matched conventional therapy in patients with stroke. Methods A pilot prospective parallel randomized controlled study at clinical settings was designed for patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 min each, five days a week for four weeks, in Robotic-therapy Group (RG) (n = 12) and conventional upper-limb rehabilitation in Control-Group (CG) (n = 11). We intended to evaluate the effects of a novel exoskeleton based therapy on the functional rehabilitation outcomes of upper-limb and cortical-excitability in patients with stroke as compared to the conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunnstrom-stage and Fugl-Meyer (FM) scale and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre- and post-therapy. Results No side effects were noticed in any of the patients. Both RG and CG showed significant (p < 0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p < 0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p < 0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p < 0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion Robotic-exoskeleton training showed improvement in motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial registry number: ISRCTN95291802 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00867-7.
Collapse
Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All Indian Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| |
Collapse
|
24
|
Matsuda D, Moriuchi T, Ikio Y, Mitsunaga W, Fujiwara K, Matsuo M, Nakamura J, Suzuki T, Sugawara K, Higashi T. A Study on the Effect of Mental Practice Using Motor Evoked Potential-Based Neurofeedback. Front Hum Neurosci 2021; 15:637401. [PMID: 33643014 PMCID: PMC7907172 DOI: 10.3389/fnhum.2021.637401] [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: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 01/10/2023] Open
Abstract
This study aimed to investigate whether the effect of mental practice (motor imagery training) can be enhanced by providing neurofeedback based on transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP). Twenty-four healthy, right-handed subjects were enrolled in this study. The subjects were randomly allocated into two groups: a group that was given correct TMS feedback (Real-FB group) and a group that was given randomized false TMS feedback (Sham-FB group). The subjects imagined pushing the switch with just timing, when the target circle overlapped a cross at the center of the computer monitor. In the Real-FB group, feedback was provided to the subjects based on the MEP amplitude measured in the trial immediately preceding motor imagery. In contrast, the subjects of the Sham-FB group were provided with a feedback value that was independent of the MEP amplitude. TMS was applied when the target, moving from right to left, overlapped the cross at the center of the screen, and the MEP amplitude was measured. The MEP was recorded in the right first dorsal interosseous muscle. We evaluated the pre-mental practice and post-mental practice motor performance in both groups. As a result, a significant difference was observed in the percentage change of error values between the Real-FB group and the Sham-FB group. Furthermore, the MEP was significantly different between the groups in the 4th and 5th sets. Therefore, it was suggested that TMS-induced MEP-based neurofeedback might enhance the effect of mental practice.
Collapse
Affiliation(s)
- Daiki Matsuda
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takefumi Moriuchi
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuta Ikio
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Wataru Mitsunaga
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kengo Fujiwara
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Moemi Matsuo
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Jiro Nakamura
- Department of Occupational Therapy, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Tomotaka Suzuki
- Faculty of Health and Social Work, Division of Physical Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Kenichi Sugawara
- Faculty of Health and Social Work, Division of Physical Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Toshio Higashi
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
25
|
Xie YL, Li W, Wang S, Yang J, Yang ZL, Wu Q, Wang YX. Improvement of P ost S troke D ysphagia by I ntermittent T heta B urst S timulation. ACUPUNCTURE ELECTRO 2021. [DOI: 10.3727/036012921x16321477053863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study aims to investigate the efficacy ofi ntermittent theta burst stimulation(iTBS) on post stroke dysphagia and its effect on the motor cortical excitability of thesuprahyoid muscle A total of 40 patients with post stroke dysphagia were randomlydivided into the iTBS and the sham stimulation groups, with the conduction of motorcortical iTBS and sham stimulation of the supraglottal muscle on the affected side,respectively . Swallowing function was assessed before (T0), immediately after (T1), andtwo weeks after (T2) cessation of the intervention using the water swallowing test (WST),standard swallowing assessment (SSA), Murray secretion scale (MSS), and PenetrationAspiration Scale ( PAS). The bilateral motor evoked potentials (MEP) of the suprahyoidmuscle were recorded After the intervention, the PAS, WST, SSA, and MSS scores weresignificantly improved in both groups (p < 0.05). The iTBS group showed a greaterchange in the PAS sco re than the sham stimulation group at T1 (p < 0.05) and a greaterchange in the WST and MSS scores at T2 (p < 0.05). The amplitude of the MEP wave ofthe suprahyoid muscle in the affected hemisphere was significantly higher in the iTBSgroup at T1 and in t he healthy hemisphere at T2 (p < 0.05). T he feasibility of applyingiTBS to the affected hemisphere for the treatment of post stroke dysphagia was directlyanalyzed for the first time. ITBS combined with conventional swallowing therapy couldbe adopted as a rehabilitation strategy to improve post stroke dysphagia.
Collapse
|
26
|
Corticomotor excitability after two different repetitive transcranial magnetic stimulation protocols in haemorrhagic stroke patients. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
27
|
Leão MT, Naros G, Gharabaghi A. Detecting poststroke cortical motor maps with biphasic single- and monophasic paired-pulse TMS. Brain Stimul 2020; 13:1102-1104. [PMID: 32418913 DOI: 10.1016/j.brs.2020.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Residual corticospinal connections are the precondition for poststroke motor recovery and necessary for targeted interventions. In severely affected patients, standard transcranial magnetic stimulation (TMS) may lead to false negative findings. OBJECTIVE Detecting the cortical representation of paralyzed forearm muscles by applying different stimulation techniques and maps beyond the hotspot. METHODS In seventeen chronic stroke patients with severe motor deficits, navigated biphasic single (SP) and monophasic paired-pulse (PP) TMS was applied at 100% stimulator output to an extended cortical area in the ipsilesional hemisphere, while recording surface EMG of the extensor carpi radialis muscle. RESULTS In eleven patients, residual connectivity to the paralyzed forearm was detected with either mapping technique (five SP and PP, four PP only, two SP only). In five patients, connections originated from non-primary motor areas. CONCLUSION These results could be instrumental for identifying candidates and stimulation targets for novel neuromodulation interventions in the context of neurorehabilitation.
Collapse
Affiliation(s)
- Maria Teresa Leão
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, And Tuebingen NeuroCampus, University of Tuebingen, Germany
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, And Tuebingen NeuroCampus, University of Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, And Tuebingen NeuroCampus, University of Tuebingen, Germany.
| |
Collapse
|
28
|
Bakker CD, Massa M, Daffertshofer A, Pasman JW, van Kuijk AA, Kwakkel G, Stegeman DF. The addition of the MEP amplitude of finger extension muscles to clinical predictors of hand function after stroke: A prospective cohort study. Restor Neurol Neurosci 2020; 37:445-456. [PMID: 31322583 DOI: 10.3233/rnn-180890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Within the first 72 hours after stroke, active finger extension is a strong predictor of long-term dexterity. Transcranial magnetic stimulation may add prognostic value to clinical assessment, which is especially relevant for patients unable to follow instructions. OBJECTIVE The current prospective cohort study aims at determining whether amplitude of motor evoked potentials of the extensor digitorum communis (EDC) can improve clinical prediction after stroke when added to clinical tests. METHODS the amplitude of motor evoked potentials of the affected EDC muscle at rest was measured in 18 participants within 4 weeks after stroke, as were the ability to perform finger extension and the Fugl-Meyer Motor Assessment of the upper extremity (FMA_UE). These three determinants were related to the FMA_UE at 26 weeks after stroke (FMA_UE26), both directly, and via the proportional recovery prediction model. The relation between amplitude of the motor evoked potentials and FMA_UE26 was evaluated for EDC. For comparison, also the MEP amplitudes of biceps brachii and adductor digiti minimi muscles were recorded. RESULTS Patients' ability to voluntarily extend the fingers was strongly related to FMA_UE26, in our cohort there were no false negative results for this predictor. Our data revealed that the relation between amplitude of motor evoked potential of EDC and FMA_UE26 was significant, but moderate (rs = 0.58) without added clinical value. The other tested muscles did not correlate significantly to FMA_UE26. CONCLUSIONS Our study demonstrates no additional value of motor evoked potential amplitude of the affected EDC muscle to the clinical test of finger extension, the latter being more strongly related to FMA_UE26.
Collapse
Affiliation(s)
- C D Bakker
- Department of Rehabilitation, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Rehabilitation Medicine, Máxima Medical Center, Veldhoven, the Netherlands
| | - M Massa
- Department of Neurology/Clinical Neurophysiology, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - A Daffertshofer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences and Institute for Brain and Behaviour Amsterdam, the Netherlands
| | - J W Pasman
- Department of Neurology/Clinical Neurophysiology, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - A A van Kuijk
- Department of Rehabilitation, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.,Tolbrug Rehabilitation Centre, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - G Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, location VU University Medical Center, MOVE Research Institute Amsterdam and Amsterdam NeuroScience, the Netherlands
| | - D F Stegeman
- Department of Neurology/Clinical Neurophysiology, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences and Institute for Brain and Behaviour Amsterdam, the Netherlands
| |
Collapse
|
29
|
Tozlu C, Edwards D, Boes A, Labar D, Tsagaris KZ, Silverstein J, Pepper Lane H, Sabuncu MR, Liu C, Kuceyeski A. Machine Learning Methods Predict Individual Upper-Limb Motor Impairment Following Therapy in Chronic Stroke. Neurorehabil Neural Repair 2020; 34:428-439. [PMID: 32193984 DOI: 10.1177/1545968320909796] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background. Accurate prediction of clinical impairment in upper-extremity motor function following therapy in chronic stroke patients is a difficult task for clinicians but is key in prescribing appropriate therapeutic strategies. Machine learning is a highly promising avenue with which to improve prediction accuracy in clinical practice. Objectives. The objective was to evaluate the performance of 5 machine learning methods in predicting postintervention upper-extremity motor impairment in chronic stroke patients using demographic, clinical, neurophysiological, and imaging input variables. Methods. A total of 102 patients (female: 31%, age 61 ± 11 years) were included. The upper-extremity Fugl-Meyer Assessment (UE-FMA) was used to assess motor impairment of the upper limb before and after intervention. Elastic net (EN), support vector machines, artificial neural networks, classification and regression trees, and random forest were used to predict postintervention UE-FMA. The performances of methods were compared using cross-validated R2. Results. EN performed significantly better than other methods in predicting postintervention UE-FMA using demographic and baseline clinical data (median REN2=0.91,RRF2=0.88,RANN2=0.83,RSVM2=0.79,RCART2=0.70; P < .05). Preintervention UE-FMA and the difference in motor threshold (MT) between the affected and unaffected hemispheres were the strongest predictors. The difference in MT had greater importance than the absence or presence of a motor-evoked potential (MEP) in the affected hemisphere. Conclusion. Machine learning methods may enable clinicians to accurately predict a chronic stroke patient's postintervention UE-FMA. Interhemispheric difference in the MT is an important predictor of chronic stroke patients' response to therapy and, therefore, could be included in prospective studies.
Collapse
Affiliation(s)
- Ceren Tozlu
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Dylan Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Edith Cowan University, Joondalup, Australia.,Burke Neurological Institute, White Plains, NY, USA
| | - Aaron Boes
- Departments of Pediatrics, Neurology & Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Douglas Labar
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Mert R Sabuncu
- School of Electrical and Computer Engineering and Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Charles Liu
- USC Neurorestoration Center, Los Angeles, CA.,Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
30
|
Harcum S, Conroy SS, Boos A, Ermer E, Xu H, Zhan M, Chen H, Whitall J, Dimyan MA, Wittenberg GF. Methods for an Investigation of Neurophysiological and Kinematic Predictors of Response to Upper Extremity Repetitive Task Practice in Chronic Stroke. Arch Rehabil Res Clin Transl 2019; 1. [PMID: 32292910 PMCID: PMC7155389 DOI: 10.1016/j.arrct.2019.100024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive task practice. Design This prospective single-group interventional study seeks to predict response to a repetitive task practice program using an intent-to-treat paradigm. Response is measured as a change of ≥5 points on the Upper Extremity Fugl-Meyer from baseline to final evaluation (at the end of training). Setting General community. Participants Anticipated enrollment of community-dwelling adults with chronic stroke (N = 96; onset≥6mo) and moderate to severe residual hemiparesis of the upper limb as defined by a score of 10-45 points on the Upper Extremity Fugl-Meyer. Intervention The intervention is a form of repetitive task practice using a combination of robot-assisted therapy coupled with functional arm use in real-world tasks administered over 12 weeks. Main Outcome Measures Upper Extremity Fugl-Meyer Assessment (primary outcome), Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, magnetic resonance imaging, transcranial magnetic stimulation, arm kinematics, accelerometry, and a saliva sample for genetic testing. Results Methods for this trial are outlined, and an illustration of interindividual variability is provided by example of 2 participants who present similarly at baseline but achieve markedly different outcomes. Conclusion This article presents the design, methodology, and rationale of an ongoing study to develop a predictive model of response to a standardized therapy for stroke survivors with chronic hemiparesis. Applying concepts from precision medicine to neurorehabilitation is practicable and needed to establish realistic rehabilitation goals and to effectively allocate resources.
Collapse
Affiliation(s)
- Stacey Harcum
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland
| | - Susan S Conroy
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland
| | - Amy Boos
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elsa Ermer
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Huichun Xu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Min Zhan
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hegang Chen
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jill Whitall
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael A Dimyan
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - George F Wittenberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatrics Research, Education, and Clinical Center Et Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
31
|
Schambra HM, Xu J, Branscheidt M, Lindquist M, Uddin J, Steiner L, Hertler B, Kim N, Berard J, Harran MD, Cortes JC, Kitago T, Luft A, Krakauer JW, Celnik PA. Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials. Neurorehabil Neural Repair 2019; 33:568-580. [PMID: 31170880 DOI: 10.1177/1545968319850138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. After stroke, recovery of movement in proximal and distal upper extremity (UE) muscles appears to follow different time courses, suggesting differences in their neural substrates. Objective. We sought to determine if presence or absence of motor evoked potentials (MEPs) differentially influences recovery of volitional contraction and strength in an arm muscle versus an intrinsic hand muscle. We also related MEP status to recovery of proximal and distal interjoint coordination and movement fractionation, as measured by the Fugl-Meyer Assessment (FMA). Methods. In 45 subjects in the year following ischemic stroke, we tracked the relationship between corticospinal tract (CST) integrity and behavioral recovery in the biceps (BIC) and first dorsal interosseous (FDI) muscle. We used transcranial magnetic stimulation to probe CST integrity, indicated by MEPs, in BIC and FDI. We used electromyography, dynamometry, and UE FMA subscores to assess muscle-specific contraction, strength, and inter-joint coordination, respectively. Results. Presence of MEPs resulted in higher likelihood of muscle contraction, greater strength, and higher FMA scores. Without MEPs, BICs could more often volitionally contract, were less weak, and had steeper strength recovery curves than FDIs; in contrast, FMA recovery curves plateaued below normal levels for both the arm and hand. Conclusions. There are shared and separate substrates for paretic UE recovery. CST integrity is necessary for interjoint coordination in both segments and for overall recovery. In its absence, alternative pathways may assist recovery of volitional contraction and strength, particularly in BIC. These findings suggest that more targeted approaches might be needed to optimize UE recovery.
Collapse
Affiliation(s)
- Heidi M Schambra
- 1 New York University School of Medicine, New York, NY, USA.,2 Columbia University, New York, NY, USA
| | - Jing Xu
- 3 Johns Hopkins University, Baltimore, MD, USA
| | - Meret Branscheidt
- 3 Johns Hopkins University, Baltimore, MD, USA.,4 University Hospital of Zurich, Zurich, Switzerland
| | | | | | - Levke Steiner
- 4 University Hospital of Zurich, Zurich, Switzerland
| | | | - Nathan Kim
- 3 Johns Hopkins University, Baltimore, MD, USA
| | | | - Michelle D Harran
- 2 Columbia University, New York, NY, USA.,3 Johns Hopkins University, Baltimore, MD, USA
| | - Juan C Cortes
- 2 Columbia University, New York, NY, USA.,3 Johns Hopkins University, Baltimore, MD, USA
| | | | - Andreas Luft
- 4 University Hospital of Zurich, Zurich, Switzerland.,5 cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | |
Collapse
|
32
|
Edwards DJ, Cortes M, Rykman-Peltz A, Chang J, Elder J, Thickbroom G, Mariman JJ, Gerber LM, Oromendia C, Krebs HI, Fregni F, Volpe BT, Pascual-Leone A. Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS. Restor Neurol Neurosci 2019; 37:167-180. [DOI: 10.3233/rnn-180869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Australia
| | - Mar Cortes
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avrielle Rykman-Peltz
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Johanna Chang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jessica Elder
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Gary Thickbroom
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Juan J. Mariman
- Metropolitan University of Educational Sciences, Santiago, Chile
- University of Chile, Neurosystems Laboratory, Santiago, Chile
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Hermano I Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA, USA
| | - Felipe Fregni
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce T. Volpe
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Beth Israel Deaconess Medical Center, Berenson-Allen Center for Noninvasive Brain Stimulation, and Harvard Medical School, Boston, MA, USA
- Institut de Neurorehabilitacio Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
| |
Collapse
|
33
|
Hanafi MH, Kassim NK, Ibrahim AH, Adnan MM, Ahmad WMAW, Idris Z, Latif LA. Cortical Modulation After Two Different Repetitive Transcranial Magnetic Stimulation Protocols in Similar Ischemic Stroke Patients. Malays J Med Sci 2019; 25:116-125. [PMID: 30918461 PMCID: PMC6422591 DOI: 10.21315/mjms2018.25.2.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/25/2018] [Indexed: 10/25/2022] Open
Abstract
Background Stroke is one of the leading causes of mortality and morbidity in Malaysia. Repetitive transcranial magnetic stimulation (rTMS) is one of the new non-invasive modality to enhance the motor recovery in stroke patients. Objectives This pilot study compared the motor evoked potential (MEP) changes using different settings of rTMS in the post-ischemic stroke patient. The goal of the study is to identify effect sizes for a further trial and evaluate safety aspects. Methods Eight post-stroke patients with upper limb hemiparesis for at least six months duration were studied in a tertiary hospital in Northeast Malaysia. Quasi experimental design was applied and the participants were randomised into two groups using software generated random numbers. One of the two settings: i) inhibitory setting, or ii) facilitatory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. A week later, a similar procedure will be repeated but using different setting than the first intervention. Each patient will serve as their own control. Repeated measures ANOVA test was applied to determine the effect sizes for both intervention through the options of partial eta-squared (η2 p). Result The study observed large effect sizes (η2 p > 0.14) for both rTMS settings in the lesion and non-lesion sides. For safety aspects, no minor or major side effects associated with the rTMS was reported by the participants. Conclusions The partial eta square of MEP value for both rTMS settings (fascilitatory and inhibitory) in both lesion and non-lesion sides represents large effect sizes. We recommend further trial to increase number of sample in order to study the effectiveness of both settings in ischemic stroke patient. Our preliminary data showed both settings may improve the MEP of the upper extremity in the ischemic stroke patient. No significant improvement noted when comparing both settings.
Collapse
Affiliation(s)
- Muhammad Hafiz Hanafi
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nur Karyatee Kassim
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Al Hafiz Ibrahim
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Munirah Mohd Adnan
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Zamzuri Idris
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Lydia Abdul Latif
- Department of Rehabilitation Medicine 2, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
34
|
Birchenall J, Térémetz M, Roca P, Lamy JC, Oppenheim C, Maier MA, Mas JL, Lamy C, Baron JC, Lindberg PG. Individual recovery profiles of manual dexterity, and relation to corticospinal lesion load and excitability after stroke -a longitudinal pilot study. Neurophysiol Clin 2018; 49:149-164. [PMID: 30391148 DOI: 10.1016/j.neucli.2018.10.065] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES In this longitudinal pilot study, we investigated how manual dexterity recovery was related to corticospinal tract (CST) injury and excitability, in six patients undergoing conventional rehabilitation. METHODS Key components of manual dexterity, namely finger force control, finger tapping rate and independence of finger movements, were quantified. Structural MRI was obtained to calculate CST lesion load. CST excitability was assessed by measuring rest motor threshold (RMT) and the amplitude of motor evoked potentials (MEPs) using transcranial magnetic stimulation (TMS). Measurements were obtained at two weeks, three and six months post-stroke. RESULTS At six months post-stroke, complete recovery of hand gross motor impairment (i.e., maximal Fugl-Meyer score for hand) had occurred in three patients and four patients had recovered ability to accurately control finger force. However, tapping rate and independence of finger movements remained impaired in all six patients at six months. Recovery in hand gross motor impairment and finger force control occurred in patients with smaller CST lesion load and almost complete recovery of CST excitability, although RMT or MEP size remained slightly altered in the stroke-affected hemisphere compared to the unaffected hemisphere. The two patients with poorest recovery showed persistent absence of MEPs and greatest structural injury to CST. DISCUSSION The findings support good motor recovery being overall correlated with smaller CST lesion, and with almost complete recovery of CST excitability. However, impairment of manual dexterity persisted despite recovery in gross hand movements and grasping abilities, suggesting involvement of additional brain structures for fine manual tasks.
Collapse
Affiliation(s)
- Julia Birchenall
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Maxime Térémetz
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France; FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - Pauline Roca
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Jean-Charles Lamy
- Inserm U 1127, CNRS UMR 7225, Sorbonne universités, UPMC université Paris 06 UMR S 1127, institut du cerveau et de la Moelle épinière, ICM, centre de neuro-imagerie de recherche (CENIR), 75013 Paris, France
| | - Catherine Oppenheim
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Marc A Maier
- FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France
| | - Jean-Louis Mas
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Catherine Lamy
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Jean-Claude Baron
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - Påvel G Lindberg
- Centre de psychiatrie et neurosciences, Inserm U894, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France; FR3636 CNRS, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
| |
Collapse
|
35
|
Visual Attention Affects the Amplitude of the Transcranial Magnetic Stimulation-associated Motor-evoked Potential: A Preliminary Study With Clinical Utility. J Psychiatr Pract 2018; 24:220-229. [PMID: 30427805 PMCID: PMC6530802 DOI: 10.1097/pra.0000000000000321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The transcranial magnetic stimulation (TMS)-elicited motor-evoked potential (MEP) is a valuable measure for clinical evaluations of various neurological disorders and is used to determine resting motor threshold for repetitive TMS dosing. Although MEP amplitude is primarily associated with motor system function, there is evidence that nonmotor factors may also influence amplitude. This experiment tested the hypotheses that manipulation of 2 factors (visual attention, cognitive regulation) in human participants would significantly affect MEP amplitude. METHODS Blocks of MEPs were recorded from the dominant right hand as participants (N=20) were instructed to shift their visual attention (toward and away from the hand) and cognitively regulate the MEPs (rest, attenuate MEP amplitude, potentiate MEP amplitude) using their thoughts (6 blocks, 20 pulses/block, randomized, 110% resting motor threshold). RESULTS MEP amplitude was significantly affected by the direction of visual attention; looking away from the hand led to higher amplitudes (P=0.003). The relationship with cognitive regulation was nonsignificant. CONCLUSIONS The significant effect of visual attention on MEP suggests that this should be a standardized parameter in clinical and research studies. These data underscore the importance of rigorous reporting of methods and use of standardized practices for MEP acquisition and TMS dosing to ensure consistent clinical measurement and treatment.
Collapse
|
36
|
Novaes MM, Palhano-Fontes F, Peres A, Mazzetto-Betti K, Pelicioni M, Andrade KC, dos Santos AC, Pontes-Neto O, Araujo D. Neurofunctional changes after a single mirror therapy intervention in chronic ischemic stroke. Int J Neurosci 2018; 128:966-974. [DOI: 10.1080/00207454.2018.1447571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Morgana M Novaes
- Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (UFRN), Natal-RN, Brazil
| | - Fernanda Palhano-Fontes
- Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (UFRN), Natal-RN, Brazil
| | - Andre Peres
- Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (UFRN), Natal-RN, Brazil
| | - Kelley Mazzetto-Betti
- Radiology Division, Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Ribeirao Preto-SP, Brazil
| | - Maristela Pelicioni
- Radiology Division, Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Ribeirao Preto-SP, Brazil
| | - Kátia C Andrade
- Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (UFRN), Natal-RN, Brazil
| | - Antonio Carlos dos Santos
- Radiology Division, Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Ribeirao Preto-SP, Brazil
| | - Octavio Pontes-Neto
- Radiology Division, Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Ribeirao Preto-SP, Brazil
| | - Draulio Araujo
- Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (UFRN), Natal-RN, Brazil
| |
Collapse
|
37
|
Stinear CM. Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol 2017; 16:826-836. [DOI: 10.1016/s1474-4422(17)30283-1] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
|
38
|
Forogh B, Ahadi T, Nazari M, Sajadi S, Abdul Latif L, Akhavan Hejazi SM, Raissi G. The Effect of Repetitive Transcranial Magnetic Stimulation on Postural Stability After Acute Stroke: A Clinical Trial. Basic Clin Neurosci 2017; 8:405-411. [PMID: 29167727 PMCID: PMC5691172 DOI: 10.18869/nirp.bcn.8.5.405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Balance impairment is a common problem and a major cause of motor disability after stroke. Therefore, this study aimed to investigate whether low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) improves the postural balance problems in stroke patients. Methods: This randomized double blind clinical trial with 12 weeks follow-up was conducted on stroke patients. Treatment was carried with 1 Hz rTMS in contralateral brain hemisphere over the primary motor area for 20 minutes (1200 pulses) for 5 consecutive days. Static postural stability, Medical Research Council (MRC), Berg Balance Scale (BBS), and Fugl-Meyer assessments were evaluated immediately, 3 weeks and 12 weeks after intervention. Results: A total of 26 patients were enrolled (age range=53 to 79 years; 61.5% were male) in this study. Administering rTMS produced a significant recovery based on BBS (df=86, 7; F=7.4; P=0.01), Fugl-Meyer Scale (df=86, 7; F=8.7; P<0.001), MRC score (df=87, 7; F=2.9; P=0.01), and static postural stability (df=87, 7; F=9.8; P<0.001) during the 12 weeks follow-up. Conclusion: According to the findings, rTMS as an adjuvant therapy may improve the static postural stability, falling risk, coordination, motor recovery, and muscle strength in patients with stroke.
Collapse
Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Tannaz Ahadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Maryam Nazari
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Lydia Abdul Latif
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seyed Majid Akhavan Hejazi
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gholamreza Raissi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| |
Collapse
|
39
|
Naeije G, Fogang Y, Ligot N, Mavroudakis N. Occipital transcranial magnetic stimulation discriminates transient neurological symptoms of vascular origin from migraine aura without headache. Neurophysiol Clin 2017; 47:269-274. [DOI: 10.1016/j.neucli.2017.05.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
|
40
|
Jang SH, Kim DH, Kim SH, Seo JP. The relation between the motor evoked potential and diffusion tensor tractography for the corticospinal tract in chronic hemiparetic patients with cerebral infarct. Somatosens Mot Res 2017; 34:134-138. [DOI: 10.1080/08990220.2017.1343188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Dea Hee Kim
- Paramedical Robot Research & Support Center, Korea Institute of Robot and Convergence, Gumi, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine Yeungnam University, Taegu, Republic of Korea
| | - Jeong Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| |
Collapse
|
41
|
Oh MK, Kim HR, Kim WS, Shin HI. Relationship Between Motor Evoked Potential Response and the Severity of Paralysis in Spinal Cord Injury Patients. Ann Rehabil Med 2017; 41:211-217. [PMID: 28503453 PMCID: PMC5426257 DOI: 10.5535/arm.2017.41.2.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/23/2016] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI). Methods We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups. Results MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above. Conclusion Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.
Collapse
Affiliation(s)
- Mi-Kyoung Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Ri Kim
- Department of Rehabilitation Medicine, National Rehabilitation Hospital, Seoul, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Individual Differences in Resting Corticospinal Excitability Are Correlated with Reaction Time and GABA Content in Motor Cortex. J Neurosci 2017; 37:2686-2696. [PMID: 28179557 DOI: 10.1523/jneurosci.3129-16.2017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/04/2017] [Accepted: 01/31/2017] [Indexed: 01/14/2023] Open
Abstract
Individuals differ in the intrinsic excitability of their corticospinal pathways and, perhaps more generally, their entire nervous system. At present, we have little understanding of the mechanisms underlying these differences and how variation in intrinsic excitability relates to behavior. Here, we examined the relationship between individual differences in intrinsic corticospinal excitability, local cortical GABA levels, and reaction time (RT) in a group of 20 healthy human adults. We measured corticospinal excitability at rest with transcranial magnetic stimulation, local concentrations of basal GABA with magnetic resonance spectroscopy, and RT with a behavioral task. All measurements were repeated in two separate sessions, and tests of reliability confirmed the presence of stable individual differences. There was a negative correlation between corticospinal excitability and RT, such that larger motor-evoked potentials (MEPs) measured at rest were associated with faster RTs. Interestingly, larger MEPs were associated with higher levels of GABA in M1, but not in three other cortical regions. Together, these results suggest that individuals with more excitable corticospinal pathways are faster to initiate planned responses and have higher levels of GABA within M1, possibly to compensate for a more excitable motor system.SIGNIFICANCE STATEMENT This study brings together physiological, behavioral, and neurochemical evidence to examine variability in the excitability of the human motor system. Previous work has focused on state-based factors (e.g., preparedness, uncertainty), with little attention given to the influence of inherent stable characteristics. Here, we examined how the excitability of the motor system relates to reaction time and the regional content of the inhibitory neurotransmitter GABA. Importantly, motor pathway excitability and GABA concentrations were measured at rest, outside a task context, providing assays of intrinsic properties of the individuals. Individuals with more excitable motor pathways had faster reaction times and, paradoxically, higher concentrations of GABA. We propose that greater GABA capacity in the motor cortex counteracts an intrinsically more excitable motor system.
Collapse
|
43
|
Cho JY, Lee A, Kim MS, Park E, Chang WH, Shin YI, Kim YH. Dual-mode noninvasive brain stimulation over the bilateral primary motor cortices in stroke patients. Restor Neurol Neurosci 2017; 35:105-114. [DOI: 10.3233/rnn-160669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jae Yong Cho
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ahee Lee
- Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University, College of Medicine, Iksan, Republic of Korea
| | - Eunhee Park
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| |
Collapse
|
44
|
Takakura T, Muragaki Y, Tamura M, Maruyama T, Nitta M, Niki C, Kawamata T. Navigated transcranial magnetic stimulation for glioma removal: prognostic value in motor function recovery from postsurgical neurological deficits. J Neurosurg 2017; 127:877-891. [PMID: 28059664 DOI: 10.3171/2016.8.jns16442] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the usefulness of navigated transcranial magnetic stimulation (nTMS) as a prognostic predictor for upper-extremity motor functional recovery from postsurgical neurological deficits. METHODS Preoperative and postoperative nTMS studies were prospectively applied in 14 patients (mean age 39 ± 12 years) who had intraparenchymal brain neoplasms located within or adjacent to the motor eloquent area in the cerebral hemisphere. Mapping by nTMS was done 3 times, i.e., before surgery, and 1 week and 3 weeks after surgery. To assess the response induced by nTMS, motor evoked potential (nTMS-MEP) was recorded using a surface electromyography electrode attached to the abductor pollicis brevis (APB). The cortical locations that elicited the largest electromyography response by nTMS were defined as hotspots. Hotspots for APB were confirmed as positive responsive sites by direct electrical stimulation (DES) during awake craniotomy. The distances between hotspots and lesions (DHS-L) were measured. Postoperative neurological deficits were assessed by manual muscle test and dynamometer. To validate the prognostic value of nTMS in recovery from upper-extremity paresis, the following were investigated: 1) the correlation between DHS-L and the serial grip strength change, and 2) the correlation between positive nTMS-MEP at 1 week after surgery and the serial grip strength change. RESULTS From the presurgical nTMS study, MEPs from targeted muscles were identified in 13 cases from affected hemispheres. In one case, MEP was not evoked due to a huge tumor. Among 9 cases from which intraoperative DES mapping for hand motor area was available, hotspots for APB identified by nTMS were concordant with DES-positive sites. Compared with the adjacent group (DHS-L < 10 mm, n = 6), the nonadjacent group (DHS-L ≥ 10 mm, n = 7) showed significantly better recovery of grip strength at 3 months after surgery (p < 0.01). There were correlations between DHS-L and recovery of grip strength at 1 week, 3 weeks, and 3 months after surgery (r = 0.74, 0.68, and 0.65, respectively). Postsurgical nTMS was accomplished in 13 patients. In 9 of 13 cases, nTMS-MEP from APB muscle was positive at 1 week after surgery. Excluding the case in which nTMS-MEP was negative from the presurgical nTMS study, recoveries in grip strength were compared between 2 groups, in which nTMS-MEP at 1 week after surgery was positive (n = 9) or negative (n = 3). Significant differences were observed between the 2 groups at 1 week, 3 weeks, and 3 months after surgery (p < 0.01). Positive nTMS-MEP at 1 week after surgery correlated well with the motor recovery at 1 week, 3 weeks, and 3 months after surgery (r = 0.87, 0.88, and 0.77, respectively). CONCLUSIONS Navigated TMS is a useful tool for identifying motor eloquent areas. The results of the present study have demonstrated the predictive value of nTMS in upper-extremity motor function recovery from postsurgical neurological deficits. The longer DHS-L and positive nTMS-MEP at 1 week after surgery have prognostic values of better recovery from postsurgical neurological deficits.
Collapse
Affiliation(s)
- Tomokazu Takakura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Physical Medicine and Rehabilitation, Tokyo Rosai Hospital, Tokyo, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Takashi Maruyama
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Masayuki Nitta
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Chiharu Niki
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| |
Collapse
|
45
|
Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia. Brain Stimul 2017; 10:75-82. [DOI: 10.1016/j.brs.2016.08.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/28/2016] [Accepted: 08/06/2016] [Indexed: 11/23/2022] Open
|
46
|
Monge-Pereira E, Molina-Rueda F, Rivas-Montero F, Ibáñez J, Serrano J, Alguacil-Diego I, Miangolarra-Page J. Electroencephalography as a post-stroke assessment method: An updated review. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
47
|
Kim B, Winstein C. Can Neurological Biomarkers of Brain Impairment Be Used to Predict Poststroke Motor Recovery? A Systematic Review. Neurorehabil Neural Repair 2016; 31:3-24. [PMID: 27503908 DOI: 10.1177/1545968316662708] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background There is growing interest to establish recovery biomarkers, especially neurological biomarkers, in order to develop new therapies and prediction models for the promotion of stroke rehabilitation and recovery. However, there is no consensus among the neurorehabilitation community about which biomarker(s) have the highest predictive value for motor recovery. Objective To review the evidence and determine which neurological biomarker(s) meet the high evidence quality criteria for use in predicting motor recovery. Methods We searched databases for prognostic neuroimaging/neurophysiological studies. Methodological quality of each study was assessed using a previously employed comprehensive 15-item rating system. Furthermore, we used the GRADE approach and ranked the overall evidence quality for each category of neurologic biomarker. Results Seventy-one articles met our inclusion criteria; 5 categories of neurologic biomarkers were identified: diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), functional magnetic resonance imaging (fMRI), conventional structural MRI (sMRI), and a combination of these biomarkers. Most studies were conducted with individuals after ischemic stroke in the acute and/or subacute stage (~70%). Less than one-third of the studies (21/71) were assessed with satisfactory methodological quality (80% or more of total quality score). Conventional structural MRI and the combination biomarker categories ranked "high" in overall evidence quality. Conclusions There were 3 prevalent methodological limitations: (a) lack of cross-validation, (b) lack of minimal clinically important difference (MCID) for motor outcomes, and (c) small sample size. More high-quality studies are needed to establish which neurological biomarkers are the best predictors of motor recovery after stroke. Finally, the quarter-century old methodological quality tool used here should be updated by inclusion of more contemporary methods and statistical approaches.
Collapse
Affiliation(s)
- Bokkyu Kim
- University of Southern California, Los Angeles, CA, USA
| | | |
Collapse
|
48
|
Hwang P, Sohn MK, Jee S, Lee H. Transcranial Motor Evoked Potentials of Lower Limbs Can Prognosticate Ambulation in Hemiplegic Stroke Patients. Ann Rehabil Med 2016; 40:383-91. [PMID: 27446774 PMCID: PMC4951356 DOI: 10.5535/arm.2016.40.3.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/24/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine the association between motor evoked potentials (MEPs) in lower limbs and ambulatory outcomes of hemiplegic stroke patients. METHODS Medical records of hemiplegic patients with the first ever stroke who received inpatient rehabilitation from January 2013 to May 2014 were reviewed. Patient who had diabetes, quadriplegia, bilateral lesion, brainstem lesion, severe musculoskeletal problem, and old age over 80 years were excluded. MEPs in lower limbs were measured when they were transferred to the Department of Rehabilitation Medicine. Subjects were categorized into three groups (normal, abnormal, and absent response) according to MEPs findings. Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) at initial and discharge were compared among the three groups by one-way analysis of variance (ANOVA). Correlation was determined using a linear regression model. RESULTS Fifty-eight hemiplegic patients were included. BBS and FAC at discharge were significantly (ANOVA, p<0.001) different according to MEPs findings. In linear regression model of BBS and FAC using stepwise selection, patients' age (p<0.01), BBS at admission (p<0.01), and MEPs (p<0.01) remained significant covariates. In regression assumption model of BBS and FAC at admission, MEPs and gender were significant covariates. CONCLUSION Initial MEPs of lower limbs can prognosticate the ambulatory outcomes of hemiplegic patients.
Collapse
Affiliation(s)
- Pyoungsik Hwang
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyunkeun Lee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
49
|
Transcranial magnetic stimulation (TMS) in stroke: Ready for clinical practice? J Clin Neurosci 2016; 31:10-4. [PMID: 27394378 DOI: 10.1016/j.jocn.2016.01.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/14/2015] [Accepted: 01/02/2016] [Indexed: 10/21/2022]
Abstract
The use of transcranial magnetic stimulation (TMS) in stroke research has increased dramatically over the last decade with two emerging and potentially useful functions identified. Firstly, the use of single pulse TMS as a tool for predicting recovery of motor function after stroke, and secondly, the use of repetitive TMS (rTMS) as a treatment adjunct aimed at modifying the excitability of the motor cortex in preparation for rehabilitation. This review discusses recent advances in the use of TMS in both prediction and treatment after stroke. Prediction of recovery after stroke is a complex process and the use of TMS alone is not sufficient to provide accurate prediction for an individual after stroke. However, when applied in conjunction with other tools such as clinical assessment and MRI, accuracy of prediction using TMS is increased. rTMS temporarily modulates cortical excitability after stroke. Very few rTMS studies are completed in the acute or sub-acute stages after stroke and the translation of altered cortical excitability into gains in motor function are modest, with little evidence of long term effects. Although gains have been made in both of these areas, further investigation is needed before these techniques can be applied in routine clinical care.
Collapse
|
50
|
Kim DH, Kyeong S, Cho Y, Jung TM, Ahn SJ, Park YG. Usefulness of voxel-based lesion mapping for predicting motor recovery in subjects with basal ganglia hemorrhage: A preliminary study with 2 case reports. Medicine (Baltimore) 2016; 95:e3838. [PMID: 27281090 PMCID: PMC4907668 DOI: 10.1097/md.0000000000003838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
It is important to estimate motor recovery in the early phase after stroke. Many studies have demonstrated that both diffusion tensor tractography (DTT) and motor-evoked potentials (MEP) are valuable predictors of motor recovery, but these modalities do not directly reflect the status of the injured gray matter. We report on 2 subjects with basal ganglia hemorrhage who showed similar DTT and MEP findings, but had markedly different clinical outcomes. Specifically, Subject 1 showed no improvement in motor function, whereas Subject 2 exhibited substantial improvement 7 weeks after onset. To determine if differences in gray matter might lend insight into these different outcomes, we analyzed gray matter lesions of the 2 subjects using a novel voxel-based lesion mapping method. The lesion of Subject 1 mainly included the putamen, thalamus, and Heschl's gyri, indicating extension of the hemorrhage in the posterior direction. In contrast, the lesion of Subject 2 mainly included the putamen, insula, and pallidum, indicating that the hemorrhage extended anterior laterally. These differential findings suggest that voxel-based gray matter lesion mapping may help to predict differential motor recovery in subjects with basal ganglia hemorrhage with similar DTT and MEP findings.
Collapse
Affiliation(s)
- Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul
| | - Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine
| | - Yoona Cho
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine
| | - Tae-min Jung
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine
| | - Sung Jun Ahn
- Department of Radiology, Yonsei University College of Medicine
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine
- ∗Correspondence: Yoon Ghil Park, Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea (e-mail: )
| |
Collapse
|