Neural Correlates of Motor Recovery Measured by SPECT at Six Months After Basal Ganglia Stroke

Frequency-Dependent Changes in Wavelet-ALFF in Patients With Acute Basal Ganglia Ischemic Stroke: A Resting-State fMRI Study

Background and Purpose: Motor impairment is a common occurrence in patients with acute basal ganglia (BG) ischemic stroke (ABGIS). However, the underlying mechanisms of poststroke motor dysfunction remain incompletely elucidated. In this study, we employed multifrequency band wavelet transform-based amplitude of low-frequency fluctuations (Wavelet-ALFFs) to investigate the alterations of spontaneous regional neural activity in patients with ABGIS. Methods: A total of 39 ABGIS patients with motor dysfunction and 45 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. Wavelet-ALFF values were calculated in the conventional frequency band (0.01-0.08 Hz), slow-5 frequency band (0.01-0.027 Hz), and slow-4 frequency band (0.027-0.073 Hz). A two-sample t-test was performed to compare the Wavelet-ALFF values between the two groups with sex as a covariate and Gaussian random field (GRF) theory (voxel p < 0.001, cluster p < 0.05, two-tailed) was used for the multiple corrections. Furthermore, spearman correlation analysis was performed to assess the relationship between alterations in regional neural activity between Fugl-Meyer Assessment (FMA) and National Institutes of Health Stroke Scale (NIHSS) scores. Results: In comparison to HCs, patients with ABGIS showed significantly increased Wavelet-ALFF in the left middle temporal gyrus (MTG) and decreased Wavelet-ALFF in the right inferior frontal operculum (IFO) across all three frequency bands (conventional, slow-4, and slow-5). In the left superior occipital gyrus (SOG), Wavelet-ALFF was decreased in the conventional frequency band but increased in the slow-4 frequency band. Additionally, patients with ABGIS demonstrated reduced Wavelet-ALFF in the right superior temporal gyrus (STG) in the conventional and slow-4 frequency bands. In the slow-5 frequency band, increased Wavelet-ALFF was observed in the left calcarine cortex (CC), left middle frontal gyrus (MFG), left supramarginal gyrus (SMG), and left postcentral gyrus (PCG), while decreased Wavelet-ALFF was noted in the right precuneus (PCu). Correlation analysis revealed that increased Wavelet-ALFF in the left CC in the slow-5 frequency band was positively correlated with the FMA score. No other correlations were detected in the conventional and slow-4 frequency bands. Conclusions: The altered spontaneous neural activity was frequency-specific in patients with ABGIS, and the slow-5 frequency band exhibited better results. Furthermore, the relationship between spontaneous brain activity and clinical characteristics highlighted patterns of neural alterations associated with motor dysfunction. These findings may provide novel insights into the neural mechanisms underlying motor dysfunction in ABGIS.

A comprehensive review for artificial intelligence on neuroimaging in rehabilitation of ischemic stroke

Stroke is the second leading cause of death worldwide, with ischemic stroke accounting for a significant proportion of morbidity and mortality among stroke patients. Ischemic stroke often causes disability and cognitive impairment in patients, which seriously affects the quality of life of patients. Therefore, how to predict the recovery of patients can provide support for clinical intervention in advance and improve the enthusiasm of patients for rehabilitation treatment. With the popularization of imaging technology, the diagnosis and treatment of ischemic stroke patients are often accompanied by a large number of imaging data. Through machine learning and Deep Learning, information from imaging data can be used more effectively. In this review, we discuss recent advances in neuroimaging, machine learning, and Deep Learning in the rehabilitation of ischemic stroke.

Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke

BACKGROUND

Sensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV).

METHODS

In total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical-subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb's biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation.

RESULTS

(1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions.

CONCLUSIONS

These results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.

Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical study

Background

Cerebrovascular reactivity (CVR) is the change in cerebral blood flow in response to a vaso-active stimulus, and may assist the treatment strategy of ischemic stroke. However, previous studies reported that a therapeutic strategy for stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters (e.g., cerebral blood flow and CVR). Hence, measurement of CVR by multimodal imaging techniques may improve the treatment of ischemic stroke.

Methods/design

This is a prospective, randomized, controlled clinical trial that aimed to examine the capability of multimodal imaging techniques for the evaluation of CVR to improve treatment of patients with ischemic stroke. A total of 66 eligible patients will be recruited from Renji Hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR > 10% group and CVR < 10% group. The patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary endpoint is all adverse events and ipsilateral stroke recurrence at 6, 12, and 24 months after management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, and 24 months.

Discussion

Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, parallel, randomized, controlled registry study, together with other ongoing studies, should present more evidence for optimal individualized accurate treatment of ischemic stroke.

Trial registration

Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16009635; Registered on 16 October 2016.

All items are from the World Health Organization Trial Registration Data Set and registration in the Chinese Clinical Trial Registry: ChiCTR-IOR-16009635.