Post Stroke Mirror Movements Preventing Performance of Bilateral Movements and Activities of Daily Living

Mirror movements (MMs) are involuntary synchronous movements of one limb during voluntary movements of the contralateral limb. Generally, MMs after stroke are observed in the unaffected hand during voluntary movements of the affected hand; MMs in the affected hand are comparatively rare. In previous studies, evaluation of MMs in the affected hand was performed using simple unilateral movement tasks, such as tapping or forceful repeated hand closure. However, the impact of MMs of the affected hand on functional tasks, such as activities of daily living (ADLs), has not been reported. We report the rare case of a patient with MMs of the affected hand due to atherothrombotic cerebral infarction of the right postcentral and precentral gyri. An 85-year-old Japanese man presented with left-sided hemiplegia and sensory impairment. MMs were observed in the left (affected) hand during many ADLs and could not be suppressed by the patient's will even when the examiner verbally instructed the patient to move only the unaffected hand. The patient was aware that his hand moved on its own, but he could not control it. The patient was trained on various types of bilateral coordinated motor exercises for 114 days after the MMs were first identified. However, this did not affect MM occurrence, and the MMs remained at the time of discharge. Future research is necessary to plan long-term interventions for MMs of the affected hand.

Asymmetry of Interhemispheric Connectivity during Rapid Movements of Right and Left Hands: A TMS-EEG Study

The interhemispheric signal propagation (ISP) obtained by electroencephalography during transcranial magnetic stimulation (TMS) allows for the assessment of the interhemispheric connectivity involved in inhibitory processes. To investigate the functional asymmetry of hemispheres during rapid movement, we compared ISP in the left and right hemispheres during rapid hand movements. In 11 healthy right-handed adults, we delivered TMS to the M1 and recorded ISP from the M1 to the contralateral hemisphere. We found that ISP from the left to right hemisphere during right-hand rapid movement was higher than ISP from the right to left hemisphere during the left-hand rapid movement. These results indicate that the left M1 strongly inhibits the right M1, and that the left hemisphere is dominant for rapid movements as well as sequential movements.

Relationship Between Motor Function, DTI, and Neurophysiological Parameters in Patients with Stroke in the Recovery Rehabilitation unit

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.

Modulation of redox potential and alteration in reactivity via the peroxide shunt pathway by mutation of cytochrome P450 around the proximal heme ligand

In the thermophilic cytochrome P450 from the thermoacidophilic crenarchaeon Sulfolobus tokodaii strain 7 (P450st), a phenylalanine residue at position 310 and an alanine residue at position 320 are located close to the heme thiolate ligand, Cys317. Single site-directed mutants F310A and A320Q and double mutant F310A/A320Q have been constructed. All mutant enzymes as well as wild-type (WT) P450st were expressed at high levels. The substitution of F310 with Ala and of A320 with Gln induced shifts in redox potential and blue shifts in Soret absorption of ferrous-CO forms, while spectral characterization showed that in the resting state, the mutants almost retained the structural integrity of the active site. The redox potential of the heme varied as follows: -481 mV (WT), -477 mV (A320Q), -453 mV (F310A), and -450 mV (F310A/A320Q). The trend in the Soret band of the ferrous-CO form was as follows: 450 nm (WT) < 449 nm (A320Q) < 446 nm (F310A) < 444 nm (F310A/A320Q). These results established that the reduction potential and electron density on the heme iron are modulated by the Phe310 and Ala320 residues in P450st. The electron density on the heme decreases in the following order: WT > A320Q > F310A > F310A/A320Q. The electron density on the heme iron infers an essential role in P450 activity. The decrease in electron density interferes with the formation of a high-valent oxo-ferryl species called Compound I. However, steady-state turnover rates of styrene epoxidation with H2O2 show the following trend: WT approximately equal to A320Q < F310A approximately equal to F310A/A320Q. The shunt pathway which can provide the two electrons and oxygen required for a P450 reaction instead of NAD(P)H and dioxygen can rule out the first and second heme reduction in the catalytic process. Because the electron density on the heme iron might be deeply involved in the k cat values in this system, the intermediate Compound 0 which is the precursor species of Compound I mainly appears to participate dominantly in epoxidation with H2O2.