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Felius RAW, Wouda NC, Geerars M, Bruijn SM, van Dieën JH, Punt M. Beyond gait speed: exploring the added value of Inertial Measurement Unit-based measurements of gait in the estimation of the walking ability in daily life. BMC Neurol 2024; 24:129. [PMID: 38627674 PMCID: PMC11022465 DOI: 10.1186/s12883-024-03632-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Gait speed is often used to estimate the walking ability in daily life in people after stroke. While measuring gait with inertial measurement units (IMUs) during clinical assessment yields additional information, it remains unclear if this information can improve the estimation of the walking ability in daily life beyond gait speed. OBJECTIVE We evaluated the additive value of IMU-based gait features over a simple gait-speed measurement in the estimation of walking ability in people after stroke. METHODS Longitudinal data during clinical stroke rehabilitation were collected. The assessment consisted of two parts and was administered every three weeks. In the first part, participants walked for two minutes (2MWT) on a fourteen-meter path with three IMUs attached to low back and feet, from which multiple gait features, including gait speed, were calculated. The dimensionality of the corresponding gait features was reduced with a principal component analysis. In the second part, gait was measured for two consecutive days using one ankle-mounted IMU. Next, three measures of walking ability in daily life were calculated, including the number of steps per day, and the average and maximal gait speed. A gait-speed-only Linear Mixed Model was used to estimate the association between gait speed and each of the three measures of walking ability. Next, the principal components (PC), derived from the 2MWT, were added to the gait-speed-only model to evaluate if they were confounders or effect modifiers. RESULTS Eighty-one participants were measured during rehabilitation, resulting in 198 2MWTs and 135 corresponding walking-performance measurements. 106 Gait features were reduced to nine PCs with 85.1% explained variance. The linear mixed models demonstrated that gait speed was weakly associated with the average and maximum gait speed in daily life and moderately associated with the number of steps per day. The PCs did not considerably improve the outcomes in comparison to the gait speed only models. CONCLUSIONS Gait in people after stroke assessed in a clinical setting with IMUs differs from their walking ability in daily life. More research is needed to determine whether these discrepancies also occur in non-laboratory settings, and to identify additional non-gait factors that influence walking ability in daily life.
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Affiliation(s)
- R A W Felius
- Research group lifestyle and health, Utrecht University of Applied Sciences, Utrecht, The Netherlands.
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - N C Wouda
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of neurorehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - M Geerars
- Physiotherapy Department Neurology, Axioncontinu, Rehabilitation Center de Parkgraaf, Utrecht, The Netherlands
| | - S M Bruijn
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J H van Dieën
- Department of Human Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Punt
- Research group lifestyle and health, Utrecht University of Applied Sciences, Utrecht, The Netherlands
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Vercalsteren E, Karampatsi D, Buizza C, Nyström T, Klein T, Paul G, Patrone C, Darsalia V. The SGLT2 inhibitor Empagliflozin promotes post-stroke functional recovery in diabetic mice. Cardiovasc Diabetol 2024; 23:88. [PMID: 38424560 PMCID: PMC10905950 DOI: 10.1186/s12933-024-02174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
Type-2 diabetes (T2D) worsens stroke recovery, amplifying post-stroke disabilities. Currently, there are no therapies targeting this important clinical problem. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are potent anti-diabetic drugs that also efficiently reduce cardiovascular death and heart failure. In addition, SGLT2i facilitate several processes implicated in stroke recovery. However, the potential efficacy of SGLT2i to improve stroke recovery in T2D has not been investigated. Therefore, we determined whether a post-stroke intervention with the SGLT2i Empagliflozin could improve stroke recovery in T2D mice. T2D was induced in C57BL6J mice by 8 months of high-fat diet feeding. Hereafter, animals were subjected to transient middle cerebral artery occlusion and treated with vehicle or the SGLTi Empagliflozin (10 mg/kg/day) starting from 3 days after stroke. A similar study in non diabetic mice was also conducted. Stroke recovery was assessed using the forepaw grip strength test. To identify potential mechanisms involved in the Empagliflozin-mediated effects, several metabolic parameters were assessed. Additionally, neuronal survival, neuroinflammation, neurogenesis and cerebral vascularization were analyzed using immunohistochemistry/quantitative microscopy. Empagliflozin significantly improved stroke recovery in T2D but not in non-diabetic mice. Improvement of functional recovery was associated with lowered glycemia, increased serum levels of fibroblast growth factor-21 (FGF-21), and the normalization of T2D-induced aberration of parenchymal pericyte density. The global T2D-epidemic and the fact that T2D is a major risk factor for stroke are drastically increasing the number of people in need of efficacious therapies to improve stroke recovery. Our data provide a strong incentive for the potential use of SGLT2i for the treatment of post-stroke sequelae in T2D.
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Affiliation(s)
- Ellen Vercalsteren
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden.
| | - Dimitra Karampatsi
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Carolina Buizza
- Translational Neurology Group, Department of Clinical Science, Wallenberg Neuroscience Center and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Thomas Nyström
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Thomas Klein
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Gesine Paul
- Translational Neurology Group, Department of Clinical Science, Wallenberg Neuroscience Center and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Cesare Patrone
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden.
| | - Vladimer Darsalia
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden.
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Tenberg A, Tahara N, Grewal A, Herrera A, Klein LM, Lebo R, Zink EK, Bahouth MN. Dysautonomia and activity in the early stroke recovery period. Neurol Sci 2024:10.1007/s10072-023-07289-4. [PMID: 38246939 DOI: 10.1007/s10072-023-07289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Maintaining cerebral perfusion in the early stages of recovery after stroke is paramount. Autoregulatory function may be impaired during this period leaving cerebral perfusion directly reliant on intravascular volume and blood pressure (BP) with increased risk for expanding cerebral infarction during periods of low BP and hemorrhagic transformation during BP elevations. We suspected that dysautonomia is common during the acute period related to both pre-existing vascular risk factors and potentially independent of such conditions. Thus, we sought to understand the state of the science specific to dysautonomia and acute stroke. The scoping review search included multiple databases and key terms related to acute stroke and dysautonomia. The team employed a rigorous review process to identify, evaluate, and summarize relevant literature. We additionally summarized common clinical approaches used to detect dysautonomia at the bedside. The purpose of this scoping review is to understand the state of the science for the identification, treatment, and impact of dysautonomia on acute stroke patient outcomes. There is a high prevalence of dysautonomia among persons with stroke, though there is significant variability in the type of measures and definitions used to diagnose dysautonomia. While dysautonomia appears to be associated with poor functional outcome and post-stroke complications, there is a paucity of high-quality evidence, and generalizability is limited by heterogenous approaches to these studies. There is a need to establish common definitions, standard measurement tools, and a roadmap for incorporating these measures into clinical practice so that larger studies can be conducted.
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Affiliation(s)
- Amelia Tenberg
- Brain Rescue Unit, Department of Neurology, Johns Hopkins School of Medicine, 600 N Wolfe St; Phipps 486, Baltimore, MD, 21287, USA
| | - Nozomi Tahara
- Department of Neuroscience Nursing, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amit Grewal
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alison Herrera
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lisa M Klein
- Department of Neuroscience Nursing, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Rachael Lebo
- Johns Hopkins School of Medicine Welch Medical Library, Baltimore, MD, USA
| | - Elizabeth K Zink
- Brain Rescue Unit, Department of Neurology, Johns Hopkins School of Medicine, 600 N Wolfe St; Phipps 486, Baltimore, MD, 21287, USA
- Department of Neuroscience Nursing, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mona N Bahouth
- Brain Rescue Unit, Department of Neurology, Johns Hopkins School of Medicine, 600 N Wolfe St; Phipps 486, Baltimore, MD, 21287, USA.
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Feng W, Domeracki A, Park C, Shah S, Chhatbar PY, Pawar S, Chang C, Hsu PC, Richardson E, Hasan D, Sokhadze E, Zhang Q, Liu H. Revisiting Transcranial Light Stimulation as a Stroke Therapeutic-Hurdles and Opportunities. Transl Stroke Res 2023; 14:854-862. [PMID: 36369294 DOI: 10.1007/s12975-022-01103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
Near-infrared laser therapy, a special form of transcranial light therapy, has been tested as an acute stroke therapy in three large clinical trials. While the NEST trials failed to show the efficacy of light therapy in human stroke patients, there are many lingering questions and lessons that can be learned. In this review, we summarize the putative mechanism of light stimulation in the setting of stroke, highlight barriers, and challenges during the translational process, and evaluate light stimulation parameters, dosages and safety issues, choice of outcomes, effect size, and patient selection criteria. In the end, we propose potential future opportunities with transcranial light stimulation as a cerebroprotective or restorative tool for future stroke treatment.
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Affiliation(s)
- Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA.
| | - Alexis Domeracki
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Christine Park
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Pratik Y Chhatbar
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Swaroop Pawar
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Cherylee Chang
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Po-Chun Hsu
- Department of Biomedical Engineering, Duke University, Durham, NC, 27710, USA
| | - Eric Richardson
- Department of Biomedical Engineering, Duke University, Durham, NC, 27710, USA
| | - David Hasan
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Estate Sokhadze
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Quanguang Zhang
- Department Department of Neurology, LSU Health Sciences Center, Shreveport, LA, 71103, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76019, USA
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Andalib S, Divani AA, Ayata C, Baig S, Arsava EM, Topcuoglu MA, Cáceres EL, Parikh V, Desai MJ, Majid A, Girolami S, Di Napoli M. Vagus Nerve Stimulation in Ischemic Stroke. Curr Neurol Neurosci Rep 2023; 23:947-962. [PMID: 38008851 PMCID: PMC10841711 DOI: 10.1007/s11910-023-01323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE OF REVIEW Vagus nerve stimulation (VNS) has emerged as a potential therapeutic approach for neurological and psychiatric disorders. In recent years, there has been increasing interest in VNS for treating ischemic stroke. This review discusses the evidence supporting VNS as a treatment option for ischemic stroke and elucidates its underlying mechanisms. RECENT FINDINGS Preclinical studies investigating VNS in stroke models have shown reduced infarct volumes and improved neurological deficits. Additionally, VNS has been found to reduce reperfusion injury. VNS may promote neuroprotection by reducing inflammation, enhancing cerebral blood flow, and modulating the release of neurotransmitters. Additionally, VNS may stimulate neuroplasticity, thereby facilitating post-stroke recovery. The Food and Drug Administration has approved invasive VNS (iVNS) combined with rehabilitation for ischemic stroke patients with moderate to severe upper limb deficits. However, iVNS is not feasible in acute stroke due to its time-sensitive nature. Non-invasive VNS (nVNS) may be an alternative approach for treating ischemic stroke. While the evidence from preclinical studies and clinical trials of nVNS is promising, the mechanisms through which VNS exerts its beneficial effects on ischemic stroke are still being elucidated. Therefore, further research is needed to better understand the efficacy and underlying mechanisms of nVNS in ischemic stroke. Moreover, large-scale randomized clinical trials are necessary to determine the optimal nVNS protocols, assess its long-term effects on stroke recovery and outcomes, and identify the potential benefits of combining nVNS with other rehabilitation strategies.
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Affiliation(s)
- Sasan Andalib
- Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Afshin A Divani
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Cenk Ayata
- Neurovascular Research Unit, Department of Radiology and Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Sheharyar Baig
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | - Vinay Parikh
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Masoom J Desai
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Arshad Majid
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Sara Girolami
- Neurological Service, SS Annunziata Hospital, Sulmona, L'Aquila, Italy
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Sulmona, L'Aquila, Italy
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Gajjar AA, Covell MM, Salem MM, Sioutas GS, Hasan S, Dinh Le AH, Srinivasan VM, Burkhardt JK. Patient sentiment regarding stroke: Analysis of 2,992 social media posts. J Stroke Cerebrovasc Dis 2023; 32:107376. [PMID: 37813085 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Social media reflects personalized sentiment toward disease and increasingly impacts perceptions of treatment options. This study aims to assess patients experience with and perception of stroke through an analysis of social media posts. METHODS A variety of terms ("stroke", "stroke survivor", "stroke rehab", "stroke recovery") were used to search for possible qualified posts on Twitter and Instagram. Twitter posts containing "#stroke" and "@stroke" were identified, yielding 2,506 Twitter posts relating to the patient's own experience. Four hundred sixty-eight public Instagram posts marked under "#stroke" and "@stroke," including direct references to the patient's own experience, were analyzed. First vs. recurrent stroke was identified when possible. The posts were coded for themes relating to patient experience with the disease. RESULTS The most common Twitter theme was raising stroke awareness (23.4 %), while spreading positivity was the most common Instagram theme (66.7 %). Most Twitter posts (93.9 %) were from patients experiencing their first stroke, with only 6.1 % of the posts being about recurrent strokes. Women created the majority of Instagram (75.7 %) and Twitter (77.3 %) posts. Men were more likely to discuss mobility/functional outcomes (p = 0.001) and survival/death (p = 0.014), while women were more likely to recount symptoms (p = 0.014), depression (p = 0.002), fear (p<0.001), and mental health (p = 0.006). CONCLUSION Stroke patients most often describe their quality of life and discuss raising awareness via social media. Men and women differ in the most commonly shared aspects of their stroke experience. Gauging social media sentiment may guide physicians toward better counseling and psychosocial management of stroke patients.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Michael M Covell
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA; School of Medicine, Georgetown University, Washington, D.C., USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sidra Hasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA; Department of Biology, Union College, Schenectady, New York, USA
| | - Anthony Huy Dinh Le
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
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Hill NM, Malone LA, Sun LR. Stroke in the Developing Brain: Neurophysiologic Implications of Stroke Timing, Location, and Comorbid Factors. Pediatr Neurol 2023; 148:37-43. [PMID: 37651976 DOI: 10.1016/j.pediatrneurol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pediatric stroke, which is unique in that it represents a static insult to a developing brain, often leads to long-term neurological disability. Neuroplasticity in infants and children influences neurophysiologic recovery patterns after stroke; therefore outcomes depend on several factors including the timing and location of stroke and the presence of comorbid conditions. METHODS In this review, we discuss the unique implications of stroke occurring in the fetal, perinatal, and childhood/adolescent time periods. First, we highlight the impact of the developmental stage of the brain at the time of insult on the motor, sensory, cognitive, speech, and behavioral domains. Next, we consider the influence of location of stroke on the presence and severity of motor and nonmotor outcomes. Finally, we discuss the impact of associated conditions on long-term outcomes and risk for stroke recurrence. RESULTS Hemiparesis is common after stroke at any age, although the severity of impairment differs by age group. Risk of epilepsy is elevated in all age groups compared with those without stroke. Outcomes in other domains vary by age, although several studies suggest worse cognitive outcomes when stroke occurs in early childhood compared with fetal and later childhood epochs. Conditions such as congenital heart disease, sickle cell disease, and moyamoya increase the risk of stroke and leave patients differentially vulnerable to neurodevelopmental delay, stroke recurrence, silent infarcts, and cognitive impairment. CONCLUSIONS A comprehensive understanding of the interplay of various factors is essential in guiding the clinical care of patients with pediatric stroke.
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Affiliation(s)
- Nayo M Hill
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Nguyen JN, Mohan EC, Pandya G, Ali U, Tan C, Kofler JK, Shapiro L, Marrelli SP, Chauhan A. CD13 facilitates immune cell migration and aggravates acute injury but promotes chronic post- stroke recovery. J Neuroinflammation 2023; 20:232. [PMID: 37817190 PMCID: PMC10566099 DOI: 10.1186/s12974-023-02918-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Acute stroke leads to the activation of myeloid cells. These cells express adhesion molecules and transmigrate to the brain, thereby aggravating injury. Chronically after stroke, repair processes, including angiogenesis, are activated and enhance post-stroke recovery. Activated myeloid cells express CD13, which facilitates their migration into the site of injury. However, angiogenic blood vessels which play a role in recovery also express CD13. Overall, the specific contribution of CD13 to acute and chronic stroke outcomes is unknown. METHODS CD13 expression was estimated in both mice and humans after the ischemic stroke. Young (8-12 weeks) male wild-type and global CD13 knockout (KO) mice were used for this study. Mice underwent 60 min of middle cerebral artery occlusion (MCAO) followed by reperfusion. For acute studies, the mice were euthanized at either 24- or 72 h post-stroke. For chronic studies, the Y-maze, Barnes maze, and the open field were performed on day 7 and day 28 post-stroke. Mice were euthanized at day 30 post-stroke and the brains were collected for assessment of inflammation, white matter injury, tissue loss, and angiogenesis. Flow cytometry was performed on days 3 and 7 post-stroke to quantify infiltrated monocytes and neutrophils and CXCL12/CXCR4 signaling. RESULTS Brain CD13 expression and infiltrated CD13+ monocytes and neutrophils increased acutely after the stroke. The brain CD13+lectin+ blood vessels increased on day 15 after the stroke. Similarly, an increase in the percentage area CD13 was observed in human stroke patients at the subacute time after stroke. Deletion of CD13 resulted in reduced infarct volume and improved neurological recovery after acute stroke. However, CD13KO mice had significantly worse memory deficits, amplified gliosis, and white matter damage compared to wild-type animals at chronic time points. CD13-deficient mice had an increased percentage of CXCL12+cells but a reduced percentage of CXCR4+cells and decreased angiogenesis at day 30 post-stroke. CONCLUSIONS CD13 is involved in the trans-migration of monocytes and neutrophils after stroke, and acutely, led to decreased infarct size and improved behavioral outcomes. However, loss of CD13 led to reductions in post-stroke angiogenesis by reducing CXCL12/CXCR4 signaling.
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Affiliation(s)
- Justin N Nguyen
- University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Eric C Mohan
- University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Gargee Pandya
- Department of Neurology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Uzma Ali
- Baylor University, Waco, TX, USA
| | - Chunfeng Tan
- Department of Neurology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Julia K Kofler
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda Shapiro
- Center for Vascular Biology, The University of Connecticut Health Center, Farmington, CT, USA
| | - Sean P Marrelli
- Department of Neurology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Anjali Chauhan
- Department of Neurology, University of Texas McGovern Medical School at Houston, Houston, TX, USA.
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Dzyubenko E, Willig KI, Yin D, Sardari M, Tokmak E, Labus P, Schmermund B, Hermann DM. Structural changes in perineuronal nets and their perforating GABAergic synapses precede motor coordination recovery post stroke. J Biomed Sci 2023; 30:76. [PMID: 37658339 PMCID: PMC10474719 DOI: 10.1186/s12929-023-00971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Stroke remains one of the leading causes of long-term disability worldwide, and the development of effective restorative therapies is hindered by an incomplete understanding of intrinsic brain recovery mechanisms. Growing evidence indicates that the brain extracellular matrix (ECM) has major implications for neuroplasticity. Here we explored how perineuronal nets (PNNs), the facet-like ECM layers surrounding fast-spiking interneurons, contribute to neurological recovery after focal cerebral ischemia in mice with and without induced stroke tolerance. METHODS We investigated the structural remodeling of PNNs after stroke using 3D superresolution stimulated emission depletion (STED) and structured illumination (SR-SIM) microscopy. Superresolution imaging allowed for the precise reconstruction of PNN morphology using graphs, which are mathematical constructs designed for topological analysis. Focal cerebral ischemia was induced by transient occlusion of the middle cerebral artery (tMCAO). PNN-associated synapses and contacts with microglia/macrophages were quantified using high-resolution confocal microscopy. RESULTS PNNs undergo transient structural changes after stroke allowing for the dynamic reorganization of GABAergic input to motor cortical L5 interneurons. The coherent remodeling of PNNs and their perforating inhibitory synapses precedes the recovery of motor coordination after stroke and depends on the severity of the ischemic injury. Morphological alterations in PNNs correlate with the increased surface of contact between activated microglia/macrophages and PNN-coated neurons. CONCLUSIONS Our data indicate a novel mechanism of post stroke neuroplasticity involving the tripartite interaction between PNNs, synapses, and microglia/macrophages. We propose that prolonging PNN loosening during the post-acute period can extend the opening neuroplasticity window into the chronic stroke phase.
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Affiliation(s)
- Egor Dzyubenko
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Katrin I Willig
- Group of Optical Nanoscopy in Neuroscience, Max Planck Institute for Multidisciplinary Sciences, City Campus, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Dongpei Yin
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Maryam Sardari
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Erdin Tokmak
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Patrick Labus
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Ben Schmermund
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Dirk M Hermann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
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10
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Alkolfat F, Abdel Galeel A, Bassiouny AR, Eldeeb H, Radwan A, Ashram YA. Patterns of Visual Task-based Functional MRI Activation in Chronic Posterior Cerebral Artery Stroke Patients. Clin Neuroradiol 2023; 33:769-781. [PMID: 36867244 PMCID: PMC10449980 DOI: 10.1007/s00062-023-01274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/29/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Stroke is a principal cause of disability worldwide. In motor stroke, the tools for stratification and prognostication are plentiful. Conversely, in stroke causing mainly visual and cognitive problems, there is still no gold standard modality to use. The purpose of this study was to explore the fMRI recruitment pattern in chronic posterior cerebral artery (PCA) stroke patients and to investigate fMRI as a biomarker of disability in these patients. METHODS The study included 10 chronic PCA stroke patients and another 10 age-matched volunteer controls. The clinical presentation, cognitive state, and performance in visual perceptual skills battery (TVPS-3) were determined for both patients and control groups. Task-based fMRI scans were acquired while performing a passive visual task. Individual and group analyses of the fMRI scans as well as correlation analysis with the clinical and behavioral data were done. RESULTS At the level of behavioral assessment there was non-selective global impairment in all visual skills subtests. On visual task-based fMRI, patients recruited more brain areas than controls. These activations were present in the ipsilesional side distributed in the ipsilesional cerebellum, dorsolateral prefrontal cortex mainly Brodmann area (BA) 9, superior parietal lobule (somatosensory associative cortex, BA 7), superior temporal gyrus (BA 22), supramarginal gyrus (BA 40), and contralesional associative visual cortex (BA 19). Spearman's rank correlation was computed to assess the relationship between the TVPS scores and the numbers of fMRI neuronal clusters in each patient above the main control activations, there was a negative correlation between the two variables, r(10) = -0.85, p ≤ 0.001. CONCLUSION In chronic PCA stroke patients with residual visual impairments, the brain attempts to recruit more neighboring and distant functional areas for executing the impaired visual skill. This intense recruitment pattern in poorly recovering patients appears to be a sign of failed compensation. Consequently, fMRI has the potential for clinically relevant prognostic assessment in patients surviving PCA stroke; however, as this study included no longitudinal data, this potential should be further investigated in longitudinal imaging studies, with a larger cohort, and multiple time points.
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Affiliation(s)
- Fatma Alkolfat
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Aya Abdel Galeel
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad R. Bassiouny
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Hany Eldeeb
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Yasmine A. Ashram
- Department of Physiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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11
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Paparella I, Vanderwalle G, Stagg CJ, Maquet P. An integrated measure of GABA to characterize post-stroke plasticity. Neuroimage Clin 2023; 39:103463. [PMID: 37406594 PMCID: PMC10339061 DOI: 10.1016/j.nicl.2023.103463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
Stroke is a major cause of death and chronic neurological disability. Despite the improvements in stroke care, the number of patients affected by stroke keeps increasing and many stroke survivors are left permanently disabled. Current therapies are limited in efficacy. Understanding the neurobiological mechanisms underlying post-stroke recovery is therefore crucial to find new therapeutic options to address this medical burden. Long-lasting and widespread alterations of γ-aminobutyric acid (GABA) neurotransmission seem to play a key role in stroke recovery. In this review we first discuss a possible model of GABAergic modulation of post-stroke plasticity. We then overview the techniques currently available to non-invasively assess GABA in patients and the conclusions drawn from this limited body of work. Finally, we address the remaining open questions to clarify GABAergic changes underlying post-stroke recovery, we briefly review possible ways to modulate GABA post stroke and propose a novel approach to thoroughly quantify GABA in stroke patients, by integrating its concentration, the activity of its receptors and its link with microstructural changes.
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Affiliation(s)
- Ilenia Paparella
- GIGA-Research, Cyclotron Research Center-In Vivo Imaging Unit, 8 allée du Six Août, Batiment B30, University of Liège, 4000 Liège, Belgium.
| | - Gilles Vanderwalle
- GIGA-Research, Cyclotron Research Center-In Vivo Imaging Unit, 8 allée du Six Août, Batiment B30, University of Liège, 4000 Liège, Belgium
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Medical Research Council Brain Network Dynamics Unit, Oxford, UK
| | - Pierre Maquet
- GIGA-Research, Cyclotron Research Center-In Vivo Imaging Unit, 8 allée du Six Août, Batiment B30, University of Liège, 4000 Liège, Belgium; Department of Neurology, Domaine Universitaire du Sart Tilman, Bâtiment B35, CHU de Liège, 4000 Liège, Belgium
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12
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Szepanowski RD, Haupeltshofer S, Vonhof SE, Frank B, Kleinschnitz C, Casas AI. Thromboinflammatory challenges in stroke pathophysiology. Semin Immunopathol 2023:10.1007/s00281-023-00994-4. [PMID: 37273022 DOI: 10.1007/s00281-023-00994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023]
Abstract
Despite years of encouraging translational research, ischemic stroke still remains as one of the highest unmet medical needs nowadays, causing a tremendous burden to health care systems worldwide. Following an ischemic insult, a complex signaling pathway emerges leading to highly interconnected thrombotic as well as neuroinflammatory signatures, the so-called thromboinflammatory cascade. Here, we thoroughly review the cell-specific and time-dependent role of different immune cell types, i.e., neutrophils, macrophages, T and B cells, as key thromboinflammatory mediators modulating the neuroinflammatory response upon stroke. Similarly, the relevance of platelets and their tight crosstalk with a variety of immune cells highlights the relevance of this cell-cell interaction during microvascular dysfunction, neovascularization, and cellular adhesion. Ultimately, we provide an up-to-date overview of therapeutic approaches mechanistically targeting thromboinflammation currently under clinical translation, especially focusing on phase I to III clinical trials.
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Affiliation(s)
- R D Szepanowski
- Department of Neurology, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen, Germany
| | - S Haupeltshofer
- Department of Neurology, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen, Germany
| | - S E Vonhof
- Department of Neurology, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen, Germany
| | - B Frank
- Department of Neurology, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen, Germany
| | - C Kleinschnitz
- Department of Neurology, University Hospital Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen, Germany.
| | - A I Casas
- Department of Neurology, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen, Germany
- Department of Pharmacology and Personalised Medicine, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
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13
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Beker MC, Aydinli FI, Caglayan AB, Beker M, Baygul O, Caglayan A, Popa-Wagner A, Doeppner TR, Hermann DM, Kilic E. Age-Associated Resilience Against Ischemic Injury in Mice Exposed to Transient Middle Cerebral Artery Occlusion. Mol Neurobiol 2023:10.1007/s12035-023-03353-4. [PMID: 37093494 DOI: 10.1007/s12035-023-03353-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
Ischemic stroke is the leading cause of death and disability. Although stroke mainly affects aged individuals, animal research is mostly one on young rodents. Here, we examined the development of ischemic injury in young (9-12-week-old) and adult (72-week-old) C57BL/6 and BALB/c mice exposed to 30 min of intraluminal middle cerebral artery occlusion (MCAo). Post-ischemic reperfusion did not differ between young and adult mice. Ischemic injury assessed by infarct area and blood-brain barrier (BBB) integrity assessed by IgG extravasation analysis was smaller in adult compared with young mice. Microvascular viability and neuronal survival assessed by CD31 and NeuN immunohistochemistry were higher in adult than young mice. Tissue protection was associated with stronger activation of cell survival pathways in adult than young mice. Microglial/macrophage accumulation and activation assessed by F4/80 immunohistochemistry were more restricted in adult than young mice, and pro- and anti-inflammatory cytokine and chemokine responses were reduced by aging. By means of liquid chromatography-mass spectrometry, we identified a hitherto unknown proteome profile comprising the upregulation of glycogen degradation-related pathways and the downregulation of mitochondrial dysfunction-related pathways, which distinguished post-ischemic responses of the aged compared with the young brain. Our study suggests that aging increases the brain's resilience against ischemic injury.
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Affiliation(s)
- Mustafa C Beker
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Fatmagul I Aydinli
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
- Department of Medical Biology, School of Medicine, Nisantasi University, Istanbul, Turkey
| | - Ahmet B Caglayan
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Merve Beker
- Department of Medical Biology, International School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Oguzhan Baygul
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Aysun Caglayan
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Aurel Popa-Wagner
- Experimental Research Center for Normal and Pathological Aging, ARES, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | | | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ertugrul Kilic
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey.
- Department of Physiology, Faculty of Medicine, Istanbul Medeniyet University, Unalan, TR-34700, Istanbul, Turkey.
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14
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Sunil S, Jiang J, Shah S, Kura S, Kilic K, Erdener SE, Ayata C, Devor A, Boas DA. Neurovascular coupling is preserved in chronic stroke recovery after targeted photothrombosis. Neuroimage Clin 2023; 38:103377. [PMID: 36948140 PMCID: PMC10034641 DOI: 10.1016/j.nicl.2023.103377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Functional neuroimaging, which measures hemodynamic responses to brain activity, has great potential for monitoring recovery in stroke patients and guiding rehabilitation during recovery. However, hemodynamic responses after stroke are almost always altered relative to responses in healthy subjects and it is still unclear if these alterations reflect the underlying brain physiology or if the alterations are purely due to vascular injury. In other words, we do not know the effect of stroke on neurovascular coupling and are therefore limited in our ability to use functional neuroimaging to accurately interpret stroke pathophysiology. To address this challenge, we simultaneously captured neural activity, through fluorescence calcium imaging, and hemodynamics, through intrinsic optical signal imaging, during longitudinal stroke recovery. Our data suggest that neurovascular coupling was preserved in the chronic phase of recovery (2 weeks and 4 weeks post-stoke) and resembled pre-stroke neurovascular coupling. This indicates that functional neuroimaging faithfully represents the underlying neural activity in chronic stroke. Further, neurovascular coupling in the sub-acute phase of stroke recovery was predictive of long-term behavioral outcomes. Stroke also resulted in increases in global brain oscillations, which showed distinct patterns between neural activity and hemodynamics. Increased neural excitability in the contralesional hemisphere was associated with increased contralesional intrahemispheric connectivity. Additionally, sub-acute increases in hemodynamic oscillations were associated with improved sensorimotor outcomes. Collectively, these results support the use of hemodynamic measures of brain activity post-stroke for predicting functional and behavioral outcomes.
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Affiliation(s)
- Smrithi Sunil
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
| | - John Jiang
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Shashwat Shah
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Sreekanth Kura
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Kivilcim Kilic
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Sefik Evren Erdener
- Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey
| | - Cenk Ayata
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anna Devor
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David A Boas
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
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15
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Alamri FF, Karamyan ST, Karamyan VT. A Low-Budget Photothrombotic Rodent Stroke Model. Methods Mol Biol 2023; 2616:21-28. [PMID: 36715924 DOI: 10.1007/978-1-0716-2926-0_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A number of animal stroke models have been developed and used over the years to study the pathological mechanisms of this disorder and develop new therapies. Among them, the photothrombotic model of ischemic stroke has been central in various studies focusing on understanding of the basic biology of neural repair, identification and validation of key molecular targets involved in post-stroke recovery, and preclinical testing of various therapeutic approaches. To facilitate uniformity among various experimental groups using this expert-recommended mouse model of choice for stroke recovery studies, in this chapter we describe in detail a low-budget technique to induce photothrombosis in the mouse primary motor cortex. Additionally, we provide tips for conducting this procedure in other cerebral cortical regions of the mouse brain and in rats.
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Affiliation(s)
- Faisal F Alamri
- College of Sciences and Health Profession, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Serob T Karamyan
- Department of Pharmacology, Faculty of Pharmacy, Yerevan State Medical University, Yerevan, Armenia
| | - Vardan T Karamyan
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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16
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Syeara N, Bagchi S, Al Shoyaib A, Karamyan ST, Alamri FF, Karamyan VT. The Finer Aspects of Grid-Walking and Cylinder Tests for Experimental Stroke Recovery Studies in Mice. Methods Mol Biol 2023; 2616:345-353. [PMID: 36715944 DOI: 10.1007/978-1-0716-2926-0_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The choice of behavioral tests and their proper execution is critically important for experimental and preclinical therapeutic stroke recovery studies, where improvement of impaired neurological function(s) is the main outcome measure. Two tests that focus on spontaneous motor behaviors of the forelimb during gait and exploratory rearing and are expert recommended for stroke recovery studies in mice are grid-walking and cylinder tasks. Both tests have been widely used in various experimental stroke studies to evaluate acute and chronic motor impairment. To facilitate adoption of these tests and consistency of use between different research laboratories, this chapter describes a simple and rigorous protocol and our schemes to successfully perform both tasks in mice and evaluate motor dysfunction and recovery after stroke. In addition, we provide practical tips to minimize experimental bias and acquire data for analyses.
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Affiliation(s)
- Nausheen Syeara
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Sounak Bagchi
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Abdullah Al Shoyaib
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Serob T Karamyan
- Department of Pharmacology, Faculty of Pharmacy, Yerevan State Medical University, Yerevan, Armenia
| | - Faisal F Alamri
- College of Sciences and Health Profession, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Vardan T Karamyan
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA. .,Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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17
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Joy MT, Bridges SP, Carmichael ST. Quantitative Spatial Mapping of Axons Across Cortical Regions to Assess Axonal Sprouting After Stroke. Methods Mol Biol 2023; 2616:171-180. [PMID: 36715934 DOI: 10.1007/978-1-0716-2926-0_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Neurological disease such as a stroke causes death of brain tissue and loss of connectivity. Paradoxically, the stroke itself induces growth of new axonal collaterals, a phenomenon that is restrained in the normal adult brain. Enhancements in sprouting of axons have been linked with enhancements in motor function. Here, we describe a method developed in-house using standard reagents to map and quantitatively assess differential sprouting responses in stroke and following treatment with candidate molecular or pharmacological targets. This method allows for measurements of axonal growth responses that act as structural correlates for neural repair processes in the brain that aid in stroke recovery.
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Affiliation(s)
- Mary T Joy
- Department of Neurology, David Geffen School of Medicine at University of California - Los Angeles, Los Angeles, CA, USA.
| | - Samuel P Bridges
- Department of Neurology, David Geffen School of Medicine at University of California - Los Angeles, Los Angeles, CA, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at University of California - Los Angeles, Los Angeles, CA, USA
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18
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Younger DS. Motor sequela of adult and pediatric stroke: Imminent losses and ultimate gains. Handb Clin Neurol 2023; 196:305-346. [PMID: 37620077 DOI: 10.1016/b978-0-323-98817-9.00025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Stroke is the leading cause of neurological disability in the United States and worldwide. Remarkable advances have been made over the past 20 years in acute vascular treatments to reduce infarct size and improve neurological outcome. Substantially less progress has been made in the understanding and clinical approaches to neurological recovery after stroke. This chapter reviews the epidemiology, bedside examination, localization approaches, and classification of stroke, with an emphasis on motor stroke presentations and management, and promising research approaches to enhancing motor aspects of stroke recovery.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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19
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Elango S, Francis AJA, Chakravarthy VS. Interaction of network and rehabilitation therapy parameters in defining recovery after stroke in a Bilateral Neural Network. J Neuroeng Rehabil 2022; 19:142. [PMID: 36536385 PMCID: PMC9762011 DOI: 10.1186/s12984-022-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive prescription that optimally maps parameters of rehabilitation with patient condition. Recovery gets further complicated once patients enter chronic phase. In this paper, we propose a rehabilitation framework based on computational modeling, capable of mapping patient characteristics to parameters of rehabilitation therapy. METHOD To build such a system, we used a simple convolutional neural network capable of performing bilateral reaching movements in 3D space using stereovision. The network was designed to have bilateral symmetry to reflect the bilaterality of the cerebral hemispheres with the two halves joined by cross-connections. This network was then modified according to 3 chosen patient characteristics-lesion size, stage of recovery (acute or chronic) and structural integrity of cross-connections (analogous to Corpus Callosum). Similarly, 3 parameters were used to define rehabilitation paradigms-movement complexity (Exploratory vs Stereotypic), hand selection mode (move only affected arm, CIMT vs move both arms, BMT), and extent of plasticity (local vs global). For each stroke condition, performance under each setting of the rehabilitation parameters was measured and results were analyzed to find the corresponding optimal rehabilitation protocol. RESULTS Upon analysis, we found that regardless of patient characteristics network showed better recovery when high complexity movements were used and no significant difference was found between the two hand selection modes. Contrary to these two parameters, optimal extent of plasticity was influenced by patient characteristics. For acute stroke, global plasticity is preferred only for larger lesions. However, for chronic, plasticity varies with structural integrity of cross-connections. Under high integrity, chronic prefers global plasticity regardless of lesion size, but with low integrity local plasticity is preferred. CONCLUSION Clinically translating the results obtained, optimal recovery may be observed when paretic arm explores the available workspace irrespective of the hand selection mode adopted. However, the extent of plasticity to be used depends on characteristics of the patient mainly stage of stroke and structural integrity. By using systems as developed in this study and modifying rehabilitation paradigms accordingly it is expected post-stroke recovery can be maximized.
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Affiliation(s)
- Sundari Elango
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - Amal Jude Ashwin Francis
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - V. Srinivasa Chakravarthy
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
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20
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Della Vecchia C, Préau M, Haesebaert J, Viprey M, Rode G, Termoz A, Dima A, Schott AM. Factors associated with post-stroke social participation: A quantitative study based on the ICF framework. Ann Phys Rehabil Med 2022; 66:101686. [PMID: 35779831 DOI: 10.1016/j.rehab.2022.101686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Post-stroke social participation is a major determinant of quality of life and life satisfaction. However, few data relating to participation determinants are available, especially the influence of psychological factors and factors related to the living environment. OBJECTIVES This study investigated determinants of post-stroke social participation within the International Classification of Functioning, Disability and Health framework. METHODS We contacted people with stroke who had been hospitalized in the Rhône County, included in a previous cohort study, were aged ≥18 years and were not institutionalized. The primary outcome was social participation measured with the Stroke Impact Scale (SIS) 2.0. We performed multiple hierarchical linear regressions to test the following predictors: clinical factors (stroke-related variables, limitations in Activities of Daily Living [ADL]/Instrumental ADL), personal factors (sociodemographic factors, coping strategies) and environmental factors (satisfaction with social relationships and living environment). RESULTS Among the 352 participants, 63% were men, and mean age was 68.7(SD 14.5) years. In the last multivariate model, variables associated with higher levels of social participation were the use of the positive thinking coping strategy (B (SD)=1.17(0.52), p = 0.03), higher perceived satisfaction with the living environment (B (SD)=0.17(0.07), p = 0.03) and fewer perceived activity limitations (B (SD)=0.55 (0.06), p < 0.001). Conversely, the seeking social support coping style (B (SD)= -1.98 (0.60), p = 0.001), and a higher number of stroke-related sequelae (B (SD)= -1.93(0.53), p = 0.001) were associated with lower social participation. CONCLUSIONS The identification of potentially modifiable personal and environmental factors that influence social participation provides elements to strengthen existing rehabilitation programs and opens the way for possible psychosocial interventions.
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Affiliation(s)
- Claire Della Vecchia
- Pole of Social Psychology, Inserm U1296 Unit 'Radiation: Defense, Health Environment', Lyon 2 University, Lyon, France.
| | - Marie Préau
- Pole of Social Psychology, Inserm U1296 Unit 'Radiation: Defense, Health Environment', Lyon 2 University, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
| | - Marie Viprey
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
| | - Gilles Rode
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron, France; Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
| | - Alexandra Dima
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
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21
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Krishnagopal S, Lohse K, Braun R. Stroke recovery phenotyping through network trajectory approaches and graph neural networks. Brain Inform 2022; 9:13. [PMID: 35717640 PMCID: PMC9206968 DOI: 10.1186/s40708-022-00160-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/23/2022] [Indexed: 11/23/2022] Open
Abstract
Stroke is a leading cause of neurological injury characterized by impairments in multiple neurological domains including cognition, language, sensory and motor functions. Clinical recovery in these domains is tracked using a wide range of measures that may be continuous, ordinal, interval or categorical in nature, which can present challenges for multivariate regression approaches. This has hindered stroke researchers’ ability to achieve an integrated picture of the complex time-evolving interactions among symptoms. Here, we use tools from network science and machine learning that are particularly well-suited to extracting underlying patterns in such data, and may assist in prediction of recovery patterns. To demonstrate the utility of this approach, we analyzed data from the NINDS tPA trial using the Trajectory Profile Clustering (TPC) method to identify distinct stroke recovery patterns for 11 different neurological domains at 5 discrete time points. Our analysis identified 3 distinct stroke trajectory profiles that align with clinically relevant stroke syndromes, characterized both by distinct clusters of symptoms, as well as differing degrees of symptom severity. We then validated our approach using graph neural networks to determine how well our model performed predictively for stratifying patients into these trajectory profiles at early vs. later time points post-stroke. We demonstrate that trajectory profile clustering is an effective method for identifying clinically relevant recovery subtypes in multidimensional longitudinal datasets, and for early prediction of symptom progression subtypes in individual patients. This paper is the first work introducing network trajectory approaches for stroke recovery phenotyping, and is aimed at enhancing the translation of such novel computational approaches for practical clinical application.
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Affiliation(s)
- Sanjukta Krishnagopal
- Gatsby Computational Neuroscience Unit, University College London, London, W1T 4JG, UK.
| | - Keith Lohse
- Physical Therapy and Neurology, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO, 63108-2212, USA
| | - Robynne Braun
- Department of Neurology, University of Maryland School of Medicine, 655 W. Baltimore Street, Bressler Research Building, 12th Floor, Baltimore, MD, 21201, USA, on behalf of the GPAS Collaboration, Phenotyping Core
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22
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Meier EL, Kelly CR, Hillis AE. Dissociable language and executive control deficits and recovery in post-stroke aphasia: An exploratory observational and case series study. Neuropsychologia 2022; 172:108270. [PMID: 35597266 PMCID: PMC9728463 DOI: 10.1016/j.neuropsychologia.2022.108270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/30/2022] [Accepted: 05/13/2022] [Indexed: 01/04/2023]
Abstract
A growing body of evidence indicates many, but not all, individuals with post-stroke aphasia experience executive dysfunction. Relationships between language and executive function skills are often reported in the literature, but the degree of interdependence between these abilities remains largely unanswered. Therefore, in this study, we investigated the extent to which language and executive control deficits dissociated in 1) acute stroke and 2) longitudinal aphasia recovery. Twenty-three individuals admitted to Johns Hopkins Hospital with a new left hemisphere stroke completed the Western Aphasia Battery-Revised (WAB-R), several additional language measures (of naming, semantics, spontaneous speech, and oral reading), and three non-linguistic cognitive tasks from the NIH Toolbox (i.e., Pattern Comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test, and Dimensional Change Card Sorting Test). Two participants with aphasia (PWA) with temporoparietal lesions, one of whom (PWA1) had greater temporal but less frontal and superior parietal damage than the other (PWA2), also completed testing at subacute (three months post-onset) and early chronic (six months post-onset) time points. In aim 1, principal component analysis on the acute test data (excluding the WAB-R) revealed language and non-linguistic executive control tasks largely loaded onto separate components. Both components were significant predictors of acute aphasia severity per the WAB-R Aphasia Quotient (AQ). Crucially, executive dysfunction explained an additional 17% of the variance in AQ beyond the explanatory power of language impairments alone. In aim 2, both case patients exhibited language and executive control deficits at the acute post-stroke stage. A dissociation was observed in longitudinal recovery of these patients. By the early chronic time point, PWA1 exhibited improved (but persistent) deficits in several language domains and recovered executive control. In contrast, PWA2 demonstrated mostly recovered language but persistent executive dysfunction. Greater damage to language and attention networks in these respective patients may explain the observed behavioral patterns. These results demonstrate that language and executive control can dissociate (at least to a degree), but both contribute to early post-stroke presentation of aphasia and likely influence longitudinal aphasia recovery.
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Affiliation(s)
| | | | - Argye E Hillis
- Department of Neurology, USA; Physical Medicine and Rehabilitation, USA; Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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23
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Pipatsrisawat S, Klaphajone J, Kitisak K, Sungkarat S, Wivatvongvana P. Effects of combining two techniques of non-invasive brain stimulation in subacute stroke patients: a pilot study. BMC Neurol 2022; 22:98. [PMID: 35300622 PMCID: PMC8928603 DOI: 10.1186/s12883-022-02607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Strokes have recently become a leading cause of disability among Thai people. Non-invasive brain stimulation (NIBS) seems to give promising results in stroke recovery when combined with standard rehabilitation programs. Objective To evaluate the combined effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and cathodal transcranial direct current stimulation (tDCS) over the non-lesional primary motor cortex on upper limb motor recovery in patients with subacute stroke. No reports of a combination of these two techniques of NIBS were found in the relevant literature. Methods This pilot study was a double-blinded, randomized controlled trial of ten patients with subacute stroke admitted to the Rehabilitation Medicine Inpatient Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. They were randomized into two groups: five in an active and five in a sham intervention group. Fugl-Meyer’s upper extremity motor score (FMA-UE) and Wolf Motor Function Test (WMFT) were used to assess motor recovery at baseline, immediately, and 1 week after stimulation. Results A two-way repeated ANOVA (mixed design) showed a significant improvement in FMA-UE scores in the active intervention group both immediately and 1 week after stimulation in comparison to the baseline, [time, F (2, 16) = 27.44, p < 0.001, time x group interaction, F (2, 16) = 13.29, p < 0.001]. Despite no statistical significance, a trend toward higher WMFT scores was shown in the active intervention group. Conclusions A single session of low-frequency rTMS and cathodal tDCS over the non-lesional primary motor cortex may enhance upper limb motor recovery in patients with subacute stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02607-3.
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Affiliation(s)
- Sutthikit Pipatsrisawat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jakkrit Klaphajone
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kittipong Kitisak
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pakorn Wivatvongvana
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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24
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: Perspectives of people with aphasia on receiving information about recovery. Neuropsychol Rehabil 2022; 33:871-902. [PMID: 35297737 DOI: 10.1080/09602011.2022.2051565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many people with aphasia (language impairment post-stroke) want to know their prognosis for recovery, yet current understanding of their experience of receiving prognoses is limited. Such insight is necessary to inform clinical practice in formulating and delivering aphasia prognoses, especially given the psycho-emotional distress and secondary adverse effects on recovery associated with conversations about prognosis. We sought an in-depth understanding of the perspectives of people with aphasia in relation to receiving prognoses post-stroke, with the aim of informing an evidence-based approach to aphasia prognostication in clinical practice. Semi-structured interviews, facilitated by communication support strategies, were conducted one-to-one with eight people with aphasia (ranging from mild to very severe) 3-12 months post-stroke. Reflexive thematic analysis was used to analyse the qualitative data, yielding two over-arching themes: (1) How would you know without knowing me?; (2) I need to know, but I don't want to know. Our findings illustrate issues of mistrust within the patient-clinician relationship, and complex emotions relating to hope and post-stroke adjustment. The present insight into the lived experience of receiving aphasia prognoses highlights the need for focused consideration of personal definitions of normalcy, measures for fostering trust, and the role of prognostic uncertainty.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
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25
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Naro A, Pignolo L, Calabrò RS. Brain Network Organization Following Post-Stroke Neurorehabilitation. Int J Neural Syst 2022; 32:2250009. [PMID: 35139774 DOI: 10.1142/s0129065722500095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Brain network analysis can offer useful information to guide the rehabilitation of post-stroke patients. We applied functional network connection models based on multiplex-multilayer network analysis (MMN) to explore functional network connectivity changes induced by robot-aided gait training (RAGT) using the Ekso, a wearable exoskeleton, and compared it to conventional overground gait training (COGT) in chronic stroke patients. We extracted the coreness of individual nodes at multiple locations in the brain from EEG recordings obtained before and after gait training in a resting state. We found that patients provided with RAGT achieved a greater motor function recovery than those receiving COGT. This difference in clinical outcome was paralleled by greater changes in connectivity patterns among different brain areas central to motor programming and execution, as well as a recruitment of other areas beyond the sensorimotor cortices and at multiple frequency ranges, contemporarily. The magnitude of these changes correlated with motor function recovery chances. Our data suggest that the use of RAGT as an add-on treatment to COGT may provide post-stroke patients with a greater modification of the functional brain network impairment following a stroke. This might have potential clinical implications if confirmed in large clinical trials.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy. Via Palermo, SS 113, Ctr. Casazza, 98124, Messina, Italy
| | - Loris Pignolo
- Sant'Anna Institute, Via Siris, 11, 88900 Crotone, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy. Via Palermo, SS 113, Ctr. Casazza, 98124, Messina, Italy
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26
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Abstract
Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.
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27
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Mohamud Yusuf A, Hagemann N, Zhang X, Zafar M, Hussner T, Bromkamp C, Martiny C, Tertel T, Börger V, Schumacher F, Solari FA, Hasenberg M, Kleinschnitz C, Doeppner TR, Kleuser B, Sickmann A, Gunzer M, Giebel B, Kolesnick R, Gulbins E, Hermann DM. Acid sphingomyelinase deactivation post-ischemia promotes brain angiogenesis and remodeling by small extracellular vesicles. Basic Res Cardiol 2022; 117:43. [PMID: 36038749 DOI: 10.1007/s00395-022-00950-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/17/2022] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
Antidepressants have been reported to enhance stroke recovery independent of the presence of depressive symptoms. They have recently been proposed to exert their mood-stabilizing actions by inhibition of acid sphingomyelinase (ASM), which catalyzes the hydrolysis of sphingomyelin to ceramide. Their restorative action post-ischemia/reperfusion (I/R) still had to be defined. Mice subjected to middle cerebral artery occlusion or cerebral microvascular endothelial cells exposed to oxygen-glucose deprivation were treated with vehicle or with the chemically and pharmacologically distinct antidepressants amitriptyline, fluoxetine or desipramine. Brain ASM activity significantly increased post-I/R, in line with elevated ceramide levels in microvessels. ASM inhibition by amitriptyline reduced ceramide levels, and increased microvascular length and branching point density in wildtype, but not sphingomyelinase phosphodiesterase-1 ([Smpd1]-/-) (i.e., ASM-deficient) mice, as assessed by 3D light sheet microscopy. In cell culture, amitriptyline, fluoxetine, and desipramine increased endothelial tube formation, migration, VEGFR2 abundance and VEGF release. This effect was abolished by Smpd1 knockdown. Mechanistically, the promotion of angiogenesis by ASM inhibitors was mediated by small extracellular vesicles (sEVs) released from endothelial cells, which exhibited enhanced uptake in target cells. Proteomic analysis of sEVs revealed that ASM deactivation differentially regulated proteins implicated in protein export, focal adhesion, and extracellular matrix interaction. In vivo, the increased angiogenesis was accompanied by a profound brain remodeling response with increased blood-brain barrier integrity, reduced leukocyte infiltrates and increased neuronal survival. Antidepressive drugs potently boost angiogenesis in an ASM-dependent way. The release of sEVs by ASM inhibitors disclosed an elegant target, via which brain remodeling post-I/R can be amplified.
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28
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Dai S, Lemaire C, Piscicelli C, Jaeger M, Chrispin A, Davoine P, Pérennou D. White matter hyperintensities do not represent a critical lateropulsion determinant after stroke. Ann Phys Rehabil Med 2021; 64:101569. [PMID: 34530152 DOI: 10.1016/j.rehab.2021.101569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/29/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Shenhao Dai
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France
| | - Camille Lemaire
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France
| | - Céline Piscicelli
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France
| | - Marie Jaeger
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France
| | - Anne Chrispin
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France
| | - Patrice Davoine
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France
| | - Dominic Pérennou
- Neurorehabilitation Department, Institute of Rehabilitation, Hôpital sud CHU Grenoble-Alpes Cs 10217, 38043 Grenoble cedex 9, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France.
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29
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Michalettos G, Walter HL, Antunes ARP, Wieloch T, Talhada D, Ruscher K. Effect of Anti-inflammatory Treatment with AMD3100 and CX 3CR1 Deficiency on GABA A Receptor Subunit and Expression of Glutamate Decarboxylase Isoforms After Stroke. Mol Neurobiol 2021; 58:5876-5889. [PMID: 34417725 PMCID: PMC8599239 DOI: 10.1007/s12035-021-02510-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
Following stroke, attenuation of detrimental inflammatory pathways might be a promising strategy to improve long-term outcome. In particular, cascades driven by pro-inflammatory chemokines interact with neurotransmitter systems such as the GABAergic system. This crosstalk might be of relevance for mechanisms of neuronal plasticity, however, detailed studies are lacking. The purpose of this study was to determine if treatment with 1,1′-[1,4-phenylenebis(methylene)]bis[1,4,8,11-tetraazacyclotetradecane] (AMD3100), an antagonist to the C-X-C chemokine receptor type 4 (CXCR4) and partial allosteric agonist to CXCR7 (AMD3100) alone or in combination with C-X3-C chemokine receptor type 1 (CX3CR1) deficiency, affect the expression of GABAA subunits and glutamate decarboxylase (GAD) isoforms. Heterozygous, CX3CR1-deficient mice and wild-type littermates were subjected to photothrombosis (PT). Treatment with AMD3100 (0.5 mg/kg twice daily i.p.) was administered starting from day 2 after induction of PT until day 14 after the insult. At this time point, GABAA receptor subunits (α3, β3, δ), GAD65 and GAD67, and CXCR4 were analyzed from the peri-infarct tissue and homotypic brain regions of the contralateral hemisphere by quantitative real-time PCR and Western Blot. Fourteen days after PT, CX3CR1 deficiency resulted in a significant decrease of the three GABAA receptor subunits in both the lesioned and the contralateral hemisphere compared to sham-operated mice. Treatment with AMD3100 promoted the down-regulation of GABAA subunits and GAD67 in the ipsilateral peri-infarct area, while the β3 subunit and the GAD isoforms were up-regulated in homotypic regions of the contralateral cortex. Changes in GABAA receptor subunits and GABA synthesis suggest that the CXCR4/7 and CX3CR1 signaling pathways are involved in the regulation of GABAergic neurotransmission in the post-ischemic brain.
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Affiliation(s)
- Georgios Michalettos
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, S-22184, Lund, Sweden
| | - Helene L Walter
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, S-22184, Lund, Sweden.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ana Rita Pombo Antunes
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, S-22184, Lund, Sweden
| | - Tadeusz Wieloch
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, S-22184, Lund, Sweden
| | - Daniela Talhada
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, S-22184, Lund, Sweden
| | - Karsten Ruscher
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, S-22184, Lund, Sweden. .,LUBIN Lab - Lunds Laboratorium För Neurokirurgisk Hjärnskadeforskning, Division of Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden.
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30
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Wanni Arachchige PR, Karunarathna S, Meidian AC, Ueda R, Uchida W, Senoo A. Structural connectivity changes in the motor execution network after stroke rehabilitation. Restor Neurol Neurosci 2021; 39:237-245. [PMID: 34275914 PMCID: PMC8543268 DOI: 10.3233/rnn-211148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Although quite a very few studies have tested structural connectivity changes following an intervention, it reflects only selected key brain regions in the motor network. Thus, the understanding of structural connectivity changes related to the motor recovery process remains unclear. Objective: This study investigated structural connectivity changes of the motor execution network following a combined intervention of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) after a stroke using graph theory approach. Methods: Fifty-six stroke patients underwent Fugl-Meyer Assessment (FMA), Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), diffusion tensor imaging (DTI), and T1 weighted imaging before and after the intervention. We examined graph theory measures related to twenty brain regions using structural connectomes. Results: The ipsilesional and contralesional hemisphere showed structural connectivity changes post-intervention after stroke. We found significantly increased regional centralities and nodal efficiency within the frontal pole and decreased degree centrality and nodal efficiency in the ipsilesional thalamus. Correlations were found between network measures and clinical assessments in the cuneus, postcentral gyrus, precentral gyrus, and putamen of the ipsilesional hemisphere. The contralesional areas such as the caudate, cerebellum, and frontal pole also showed significant correlations. Conclusions: This study was helpful to expand the understanding of structural connectivity changes in both hemispheric networks during the motor recovery process following LF-rTMS and intensive OT after stroke.
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Affiliation(s)
| | - Sadhani Karunarathna
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Department of Radiography/Radiotherapy, Faculty of Allied Health Sciences, University of Peradeniya
| | - Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Atsushi Senoo
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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31
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Wang L, Xu X, Kai Lau K, Li LSW, Kwun Wong Y, Yau C, Mak HKF, Hui ES. Relation between rich-club organization versus brain functions and functional recovery after acute ischemic stroke. Brain Res 2021; 1763:147441. [PMID: 33753065 DOI: 10.1016/j.brainres.2021.147441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 02/04/2023]
Abstract
Studies have shown the brain's rich-club organization may underpin brain function and be associated with various brain disorders. In this study, we aimed to investigate the relation between poststroke brain functions and functional recovery versus the rich-club organization of the structural brain network of patients after first-time acute ischemic stroke. A cohort of 16 acute ischemic stroke patients (11 males) was recruited. Structural brain networks were measured using diffusion tensor imaging within 1 week and at 1, 3 and 6 months after stroke. Motor impairment was assessed using the Upper-Extremity Fugl-Meyer motor scale and activities of daily living using the Barthel Index at the same time points as MRI. The rich-club regions that were stable over the course of stroke recovery included the bilateral dorsolateral superior frontal gyri, right supplementary motor area, and left median cingulate and paracingulate gyri. The network properties that correlated with poststroke brain functions were mainly the ratio between communication cost ratio and density ratio of rich-club, feeder and local connections. The recovery of both motor functions and activities of daily living were correlated with higher normalized rich club coefficients and a shorter length of local connections within a week after stroke. The communication cost ratio of feeder connections, the length of rich-club and local connections, and normalized rich club coefficients were found to be potential prognostic indicators of stroke recovery. Our results provide additional support to the notion that different types of network connections play different roles in brain functions as well as functional recovery.
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Affiliation(s)
- Lu Wang
- Department of Diagnostic Radiology, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Xiaopei Xu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Kui Kai Lau
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Leonard S W Li
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Yuen Kwun Wong
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Christina Yau
- Department of Occupational Therapy, Tung Wah Hospital, Hong Kong Special Administrative Region
| | - Henry K F Mak
- Department of Diagnostic Radiology, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Edward S Hui
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Special Administrative Region.
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32
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Carvalho LB, Chambers B, Borschmann K, Kaffenberger T, Churilov L, Thijs V, Bernhardt J. Occlusive Disease and Upright Activity in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105604. [PMID: 33476962 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/26/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
The impact of out-of-bed upright activity on outcomes in ischemic stroke patients with severe extra- and intracranial stenosis or occlusion is unknown. Using ultrasound findings from a cohort recruited to A Very Early Rehabilitation Trial (AVERT) which compared higher dose very early mobilisation (VEM) to usual care (UC), we aimed to explore the association between occlusive disease and 3-month outcomes and occlusive disease-by-mobilisation treatment interactions. Participants with ischemic stroke, with carotid and transcranial Doppler ultrasounds performed ≤1 week after admission, were included in this single centre substudy in Melbourne, Australia. Reports were retrospectively reviewed to determine the degree of stenosis or presence of occlusion in the relevant arterial territory. Stenosis ≥70% extracranial or ≥50% intracranial were classified as severe or occlusion. Overall, 19% (n = 36/191) had occlusive disease in the affected circulation. About 40% (n = 14/36) with occlusive disease and 51% (n = 79/155) without had a 3-month favourable outcome (mRS 0-2) (adjusted OR0.53, CI0.17-1.67). Fourteen percent (n = 5) with occlusive disease and 4% (n = 6) without died by 3 months (adjusted OR2.52, CI0.6-10.7). Fifty percent (n = 11/22) of UC (adjusted OR0.86, CI0.23-3.2) and 21% (n = 3/14) of VEM participants (adjusted OR0.16, CI0.01-2.7) with occlusive disease had a favourable outcome. Almost 30% (n = 4) VEM participants with occlusive disease died (adjusted OR3.99, CI0.69-22.9) compared to 5% (n = 1) UC participants with occlusive disease (adjusted OR0.45, CI0.02-8.6), however numbers were small. No stenosis-by-treatment interactions were found. High quality prospective studies are needed to help guide decision making about when patients with occlusive disease should commence upright activity in acute stroke.
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Affiliation(s)
- Lilian B Carvalho
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia; NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia.
| | - Brian Chambers
- Department of Neurology, Austin Health, Australia; Department of Medicine, University of Melbourne, Australia
| | - Karen Borschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia; NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia; St Vincent's Hospital, Melbourne, Australia
| | - Tina Kaffenberger
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Australia
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia; Department of Neurology, Austin Health, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia; NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia
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Yang Y, Yang LY, Salayandia VM, Thompson JF, Torbey M, Yang Y. Treatment with Atorvastatin During Vascular Remodeling Promotes Pericyte-Mediated Blood-Brain Barrier Maturation Following Ischemic Stroke. Transl Stroke Res 2021; 12:905-22. [PMID: 33423214 DOI: 10.1007/s12975-020-00883-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
We previously showed that newly formed vessels in ischemic rat brain have high blood-brain barrier (BBB) permeability at 3 weeks after stroke due to a lack of major endothelial tight junction proteins (TJPs), which may exacerbate edema in stroke patients. Atorvastatin was suggested a dose-dependent pro-angiogenic effect and ameliorating BBB permeability beyond its cholesterol-lowering effects. This study examined our hypothesis that, during vascular remodeling after stroke, treatment with atorvastatin could facilitate BBB maturation in remodeling vasculature in ischemic brain. Adult spontaneously hypertensive rats underwent middle cerebral artery occlusion with reperfusion (MCAO/RP). Atorvastatin, at dose of 3 mg/kg, was delivered daily starting at 14 days after MCAO/RP onset for 7 days. The rats were studied at multiple time points up to 8 weeks with multimodal-MRI, behavior tests, immunohistochemistry, and biochemistry. The delayed treatment of atorvastatin significantly reduced infarct size and BBB permeability, restored cerebral blood flow, and improved the neurological outcome at 8 weeks after MCAO/RP. Postmortem studies showed that atorvastatin promoted angiogenesis and stabilized the newly formed vessels in peri-infarct areas. Importantly, atorvastatin facilitated maturation of BBB properties in the new vessels by promoting endothelial tight junction (TJ) formation. Further in vivo and in vitro studies demonstrated that proliferating peri-vascular pericytes expressing neural-glial antigen 2 (NG2) mediated the role of atorvastatin on BBB maturation through regulating endothelial TJ strand formations. Our results suggested a therapeutic potential of atorvastatin in facilitating a full BBB integrity and functional stroke recovery, and an essential role for pericyte-mediated endothelial TJ formation in remodeling vasculature.
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Tan CHN, Choy D, Venketasubramanian N. NeuroAid II (MLC901) in Haemorrhagic Stroke. Case Rep Neurol 2020; 12:212-217. [PMID: 33505298 DOI: 10.1159/000508588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/09/2020] [Indexed: 11/19/2022] Open
Abstract
Stroke is a leading cause of death and disability. NeuroAid (MLC601), which originates from Traditional Chinese Medicine, comprises herbal and animal components, and has been shown to improve the functional status of patients after ischaemic stroke. The use of NeuroAid II (MLC901), which comprises only the herbal components of MLC601, in haemorrhagic stroke has not been previously reported. Our patient is a 63-year-old male with a significant stroke risk factor of hypertension. He developed visual field defect, aphasia, unilateral weakness, and hemisensory loss. CT scan showed a left thalamic haemorrhage. In addition to anti-hypertensive therapy and intensive rehabilitation, he was prescribed MLC901. Over a period of 6 months, he had significant improvements in his motor, sensory, and speech function. There were no adverse events, serial brain CT scans showed resolution of the haemorrhage. MLC901 may have a role in post-stroke recovery after intracranial haemorrhage.
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Affiliation(s)
- Chai-Hoon Nowel Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Choy
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
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Epple C, Maurer-Burkhard B, Lichti MC, Steiner T. Vojta therapy improves postural control in very early stroke rehabilitation: a randomised controlled pilot trial. Neurol Res Pract 2020; 2:23. [PMID: 33324926 DOI: 10.1186/s42466-020-00070-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022] Open
Abstract
Background It is still unclear, which physiotherapeutic approaches are most effective in stroke recovery. Vojta therapy is a type of physiotherapy that was originally developed for children and adolescents with cerebral palsy. Vojta therapy has been reported to improve automatic control of body posture. Because acute stroke patients are characterised by a disturbance in the ability to adapt to changes in body position, requiring automatic postural adjustment, we decided to investigate Vojta therapy in the early rehabilitation of stroke patients. Aim of the trial was to test the hypothesis that Vojta therapy - as a new physiotherapeutic approach in early stroke recovery - improves postural control and motor function in patients with acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Methods This prospective, randomised controlled trial included patients with imaging-confirmed AIS or ICH, severe hemiparesis and randomly assigned them to Vojta therapy or standard physiotherapy within 72 h after stroke onset. Main exclusion criterion was restricted ability to communicate. Primary endpoint was the improvement of postural control measured by the Trunk Control Test (TCT) on day 9 after admission. Secondary endpoint among others was improvement of arm function (measured with Motor Evaluation Scale for Upper Extremity in Stroke Patients [MESUPES]). Results Forty patients (20 per group) were randomised into the trial. Median age was 75 (66-80) years, 50% were women. The median improvement in TCT within 9 days was 25.5 points (=25.5%) (interquartile range [IQR] 12.5-42.5) in the Vojta group and 0 (IQR 0-13) in the control group (p = 0.001). Patients treated with Vojta therapy achieved a greater improvement in the MESUPES than patients in the control group (20% vs 10%, p = 0.006). Conclusion This first randomised controlled trial of Vojta therapy in acute stroke patients demonstrates improvement of postural control through Vojta therapy compared to standard physiotherapy. Although this trial has some methodical weaknesses, Vojta therapy might be a promising approach in early stroke rehabilitation and should be studied in larger trials. Trial registration ClinicalTrials.gov; Unique identifier: NCT03035968. Registered 30 January 2017 - Retrospectively registered; http://www.clinicaltrials.gov.
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Tao Y, Rapp B. How functional network connectivity changes as a result of lesion and recovery: An investigation of the network phenotype of stroke. Cortex 2020; 131:17-41. [PMID: 32781259 DOI: 10.1016/j.cortex.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/15/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
This study, through a series of univariate and multivariate (classification) analyses, investigated fMRI task-based functional connectivity (FC) at pre- and post-treatment time-points in 18 individuals with chronic post-stroke dysgraphia. The investigation examined the effects of lesion and treatment-based recovery on functional organization, focusing on both inter-hemispheric (homotopic) and intra-hemispheric connectivity. The work confirmed, in the chronic stage, the "network phenotype of stroke injury" proposed by Siegel et al. (2016) consisting of abnormally low inter-hemispheric connectivity as well as abnormally high intra-hemispheric (ipsilesional) connectivity. In terms of recovery-based changes in FC, this study found overall hyper-normalization of these abnormal inter and intra-hemispheric connectivity patterns, suggestive of over-correction. Specifically, treatment-related homotopic FC increases were observed between left and right dorsal frontal-parietal regions. With regard to intra-hemispheric connections, recovery was dominated by increased ipsilateral connectivity between frontal and parietal regions along with decreased connectivity between the frontal regions and posterior parietal-occipital-temporal areas. Both inter and intra-hemispheric changes were associated with treatment-driven improvements in spelling performance. We suggest an interpretation according to which, with treatment, as posterior orthographic processing areas become more effective, executive control from frontal-parietal networks becomes less necessary.
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Affiliation(s)
- Yuan Tao
- Department of Cognitive Science, Johns Hopkins University, USA.
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, USA; Department of Neuroscience, Johns Hopkins University, USA; Department of Psychological and Brain Sciences, Johns Hopkins University, USA
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Abstract
PURPOSE OF REVIEW Recent advances in the machine learning field, especially in deep learning, provide the opportunity for automated, detailed, and unbiased analysis of motor behavior. Although there has not yet been wide use of these techniques in the motor rehabilitation field, they have great potential. In this review, I describe how the current state of machine learning can be applied to 3D kinematic analysis, and how this will have an impact on neurorehabilitation. RECENT FINDINGS Applications of deep learning methods, in the form of convolutional neural networks, have been revolutionary for image analysis such as face recognition and object detection in images, exceeding human level performance. Recent studies have shown applicability of these deep learning approaches to human posture and movement classification. It is to be expected that portable stereo-camera systems will bring 3D pose estimation into the clinical setting and allow the assessment of movement quality in response to interventions. Advances in machine learning can help automate the process of obtaining 3D kinematics of human movements and to identify/classify patterns of movement.
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Affiliation(s)
- Ahmet Arac
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Rm 3-232, Los Angeles, CA, 90095, USA.
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Pallast N, Wieters F, Nill M, Fink GR, Aswendt M. Graph theoretical quantification of white matter reorganization after cortical stroke in mice. Neuroimage 2020; 217:116873. [PMID: 32380139 DOI: 10.1016/j.neuroimage.2020.116873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/11/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023] Open
Abstract
Stroke is a devastating disease leading to cell death and disconnection between neurons both locally and remote, often resulting in severe long-term disability. Spontaneous reorganization of areas and pathways not primarily affected by ischemia is, however, associated with albeit limited recovery of function. Quantitative mapping of whole-brain changes of structural connectivity concerning the ischemia-induced sensorimotor deficit and recovery thereof would help to target structural plasticity in order to improve rehabilitation. Currently, only in vivo diffusion MRI can extract the structural whole-brain connectome noninvasively. This approach is, however, used primarily in human studies. Here, we applied atlas-based MRI analysis and graph theory to DTI in wild-type mice with cortical stroke lesions. Using a DTI network approach and graph theory, we aimed at gaining insights into the dynamics of the spontaneous reorganization after stroke related to the recovery of function. We found evidence for altered structural integrity of connections of specific brain regions, including the breakdown of connections between brain regions directly affected by stroke as well as long-range rerouting of intra- and transhemispheric connections related to improved sensorimotor behavior.
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Affiliation(s)
- Niklas Pallast
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Frederique Wieters
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Marieke Nill
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Germany
| | - Markus Aswendt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Germany.
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Lundström E, Isaksson E, Näsman P, Wester P, Mårtensson B, Norrving B, Wallén H, Borg J, Dennis M, Mead G, Hankey GJ, Hackett ML, Sunnerhagen KS. Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden. Trials 2020; 21:233. [PMID: 32111264 PMCID: PMC7048055 DOI: 10.1186/s13063-020-4124-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022] Open
Abstract
Studies have suggested that fluoxetine might improve neurological recovery after stroke, but the results remain inconclusive. The EFFECTS (Efficacy oF Fluoxetine - a randomisEd Controlled Trial in Stroke) reached its recruitment target of 1500 patients in June 2019. The purpose of this article is to present all amendments to the protocol and describe how we formed the EFFECTS trial collaboration in Sweden. METHODS In this investigator-led, multicentre, parallel-group, randomised, placebo-controlled trial, we enrolled non-depressed stroke patients aged 18 years or older between 2 and 15 days after stroke onset. The patients had a clinical diagnosis of stroke (ischaemic or intracerebral haemorrhage) with persisting focal neurological deficits. Patients were randomised to fluoxetine 20 mg or matching placebo capsules once daily for 6 months. RESULTS Seven amendments were made and included clarification of drug interaction between fluoxetine and metoprolol and the use of metoprolol for severe heart failure as an exclusion criterion, inclusion of data from central Swedish registries and the Swedish Stroke Register, changes in informed consent from patients, and clarification of design of some sub-studies. EFFECTS recruited 1500 patients at 35 centres in Sweden between 20 October 2014 and 28 June 2019. We plan to unblind the data in January 2020 and report the primary outcome in May 2020. CONCLUSION EFFECTS will provide data on the safety and efficacy of 6 months of treatment with fluoxetine after stroke in a Swedish health system setting. The data from EFFECTS will also contribute to an individual patient data meta-analysis. TRIAL REGISTRATION EudraCT 2011-006130-16. Registered on 8 August 2014. ISRCTN, ISRCTN13020412. Registered on 19 December 2014. ClinicalTrials.gov: NCT02683213. Retrospectively registered on 2 February 2016.
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Affiliation(s)
- Erik Lundström
- Department of Neuroscience, Neurology, Uppsala University, Akademiska Sjukhuset, SE-751 85, Uppsala, Sweden.
| | - Eva Isaksson
- Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Nobels väg 6, SE-171 76, Stockholm, Sweden
| | - Per Näsman
- Centre for Safety Research, KTH Royal Institute of Technology, TR10 B, SE-100 44, Stockholm, Sweden
| | - Per Wester
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Björn Mårtensson
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Lund, Neurology, Skåne University Hospital, Lund University, SE-221 85, Lund, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
| | - Jörgen Borg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
| | - Martin Dennis
- Royal Infirmary, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Gillian Mead
- Royal Infirmary, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Perth, Australia
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
- The University of Central Lancashire, Preston, UK
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Riga Stradins University, Riga, Latvia
- Sunnaas Rehabilitation Hospital, Bjørnemy, Norway
- Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Häggman Henrikson J, Pombo Antunes AR, Wieloch T, Ruscher K. Enhanced functional recovery by levodopa is associated with decreased levels of synaptogyrin following stroke in aged mice. Brain Res Bull 2019; 155:61-66. [PMID: 31805305 DOI: 10.1016/j.brainresbull.2019.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
Levodopa is a precursor to dopamine that has been shown to improve functional recovery following stroke partly achieved through mechanisms of brain plasticity. This study investigates if dopamine might affect plasticity by having a direct effect on synaptic plasticity through alterations in neurotransmitter release and re-uptake. Synaptogyrin is a synaptic vesicle protein that has been suggested to be involved in dopamine re-uptake in the synaptic terminal. Therefore, we investigated if levodopa has an effect on the expression of synaptogyrin 1. Thy1-YFP mice were subjected to photothrombosis as an experimental model of stroke. Starting two days after surgery they were treated with either levodopa or a vehicle solution (saline) on a daily basis until day seven following surgery. On day seven they were sacrificed and their brains stained for Dopamine 1 receptor (D1R), Dopamine 2 receptor (D2R) and Parvalbumin (PV). Neu-N stainings were used to estimate infarct size. A second group of mice were subjected to photothrombosis and also treated with either levodopa or a vehicle solution in the same manner as previously mentioned. On day seven they were then sacrificed, and samples of brain tissue were taken for protein determination. Western blots were carried out to investigate possible differences in synaptogyrin expression between the two groups. Immunofluorescent stains showed the presence of dopamine receptors on the YFP-positive neurons and on PV-expressing neurones. Our Western Blot analysis showed a significant decrease in the expression of synaptogyrin in levodopa-treated mice. Our stains showed co-localisation with Thy-1 neurones and PV-expressing neurones for both D1 and D2 receptors. This indicates that dopamine has the ability to bind to, and directly influence cortical neurons, as well as inhibitory interneurons. We discovered a considerable decrease in synaptogyrin expression through levodopa treatment, suggesting that this might be a mechanism for regulating brain plasticity.
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Affiliation(s)
- Jens Häggman Henrikson
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, 22184, Lund, Sweden
| | - Ana Rita Pombo Antunes
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, 22184, Lund, Sweden
| | - Tadeusz Wieloch
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, 22184, Lund, Sweden
| | - Karsten Ruscher
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University, BMC A13, 22184, Lund, Sweden; LUBIN Lab - Lunds Laboratorium för Neurokirurgisk Hjärnskadeforskning, Division of Neurosurgery, Department of Clinical Sciences, Lund University, Sweden.
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Rattan A, Kataria R, Kumar A, Azam Q. Blunt carotid injury with thrombotic occlusion: Is an intervention always required for best outcome? Trauma Case Rep 2019; 24:100263. [PMID: 31872027 PMCID: PMC6911937 DOI: 10.1016/j.tcr.2019.100263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 01/26/2023] Open
Abstract
Blunt cerebrovascular injuries are rare, comprises of 0.08 to 0.33% of all traumatic blunt injuries. Depending on the grade of severity, they may heal with minimal consequences or may lead to debilitating and devastating stroke. Surgically accessible lesions are infrequent and hence endovascular management is preferred modality for high-grade lesions. We hereby present a case of complete thrombosis of the common carotid artery, which couldn't receive either surgical or endovascular treatment due to low resource settings. The patient developed a stroke after 18 h of trauma, which, however, recovered completely and dramatically within 96 h. To the best of our knowledge, such rapid and complete recovery from stroke secondary to blunt carotid injury managed non-operatively hasn't been reported in literature so far. Our report adds to the scarce but growing body of evidence recommending conservative management in BCVI in absence of enlarging pseudoaneurysm and dissection with near-complete stenosis.
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Affiliation(s)
- Amulya Rattan
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Ruby Kataria
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Ajay Kumar
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Quamar Azam
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
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Costa-García Á, Ozaki KI, Yamasaki H, Itkonen M, S FA, Okajima S, Tanimoto M, Kondo I, Shimoda S. Model for prompt and effective classification of motion recovery after stroke considering muscle strength and coordination factors. J Neuroeng Rehabil 2019; 16:130. [PMID: 31684980 PMCID: PMC6829968 DOI: 10.1186/s12984-019-0611-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Muscle synergies are now widely discussed as a method for evaluating the existence of redundant neural networks that can be activated to enhance stroke rehabilitation. However, this approach was initially conceived to study muscle coordination during learned motions in healthy individuals. After brain damage, there are several neural adaptations that contribute to the recovery of motor strength, with muscle coordination being one of them. In this study, a model is proposed that assesses motion based on surface electromyography (sEMG) according to two main factors closely related to the neural adaptations underlying motor recovery: (1) the correct coordination of the muscles involved in a particular motion and (2) the ability to tune the effective strength of each muscle through muscle fiber contractions. These two factors are hypothesized to be affected differently by brain damage. Therefore, their independent evaluation will play an important role in understanding the origin of stroke-related motor impairments. Results The model proposed was validated by analyzing sEMG data from 18 stroke patients with different paralysis levels and 30 healthy subjects. While the factors necessary to describe motion were stable across heathy subjects, there was an increasing disassociation for stroke patients with severe motor impairment. Conclusions The clear dissociation between the coordination of muscles and the tuning of their strength demonstrates the importance of evaluating these factors in order to choose appropriate rehabilitation therapies. The model described in this research provides an efficient approach to promptly evaluate these factors through the use of two intuitive indexes.
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Affiliation(s)
- Álvaro Costa-García
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan.
| | - Ken-Ichi Ozaki
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Hiroshi Yamasaki
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Matti Itkonen
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Fady Alnajjar S
- Intelligent Robot Interaction Lab, College of Information Technology, United Arab Emirates University, Abu Dhabi, 15551, United Arab Emirates
| | - Shotaro Okajima
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Masanori Tanimoto
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Izumi Kondo
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Shingo Shimoda
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
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Guo S, Som AT, Arai K, Lo EH. Effects of angiotensin-II on brain endothelial cell permeability via PPARalpha regulation of para- and trans-cellular pathways. Brain Res 2019; 1722:146353. [PMID: 31356784 PMCID: PMC6755037 DOI: 10.1016/j.brainres.2019.146353] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022]
Abstract
Angiotensin-II (Ang-II) is a key factor in hypertension, diabetes and aging, which are all primary risk factors for CNS disease. Furthermore, Ang-II may play under-appreciated roles in neurogenesis, angiogenesis and CNS remodeling. Therefore, any contemplated attempts for neurorestorative therapies in the CNS should consider the context of Ang-II signaling. Here, we investigate how Ang-II may regulate cerebral endothelial permeability, a key functional feature of the neurovascular unit. Exposure of human brain endothelial cell cultures to Ang-II increased its permeability to BSA-Alexa488 tracer. Immunocytochemistry and pulse-chase experiments suggested that both para-cellular as well as trans-cellular pathways were involved. Candesartan but not PD123319 blocked Ang-II permeability effects, suggesting that Ang-II effects may be mediated via type 1 receptor. Immunocytochemistry and western blots showed that Ang-II disrupted the membrane distributions of ZO-1 and VE-Cad, decreased total levels of JAM-A and Mfsd2a, and increased Cav1. These effects of Ang-II were accompanied by dephosphorylation of PPARalpha. Finally, Ang-II-induced increases in endothelial permeability were ameliorated by PPARalpha agonists. Taken together, these studies suggest that Ang-II may disrupt both para- and trans-cellular permeability in cerebral endothelium, and PPARalpha-related pathways may offer potential therapeutic targets for ameliorating these effects in cell-based regenerative medicine.
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Affiliation(s)
- Shuzhen Guo
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, United States.
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Ye L, Cao L, Xie H, Shan G, Hu J, Du J, Song W. Visual processing features in patients with visual spatial neglect recovering from right-hemispheric stroke. Neurosci Lett 2019; 714:134528. [PMID: 31585212 DOI: 10.1016/j.neulet.2019.134528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Visual spatial neglect (VSN) is a disorder of spatial-temporal attention, often as a result of traumatic brain injury, including stroke. Accumulating evidence suggests that the recovery from VSN follows a very predictable pattern. In this study, we aimed to determine the specific electrophysiology readout that might have predictive value for recovery from VSN in the typical early events, including the recovery rate of visual processing, within the first four weeks of recovery. METHODS This was a prospective study of 18 right ischemic stroke patients with VSN who performed a visual cue-target task within 3 days after stroke. The patients were divided into two groups according to their outcome. We compared behavioral data, the amplitudes and latencies of ERP components(P1, N1, and P300) between patients with persistent-VSN (P-VSN) and those with rapid recovery-VSN (R-VSN). RESULTS The amplitudes and latencies of the P1 and N1 components were not significantly influenced by the validity of the cue-based expectancy (all p > 0.05). However, a longer mean P300 latency evoked an effective cue (p < 0.001), and there was a significant difference between the P-VSN and R-VSN groups when using the left target (left hemisphere, p = 0.014; right hemisphere, p = 0.027). The recovery rate found in our study (18.75% at four weeks after stroke) was lower than that of previously reported studies. CONCLUSIONS Our findings support the use of the event-related potential as a tool for investigating rapid recovery from VSN after stroke and suggest that other factors, such as an asymmetrical omission toward the contralateral side or impairment in the temporal processing capacity, might also be potential biomarkers of recovery.
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Affiliation(s)
- Linlin Ye
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China
| | - Lei Cao
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China
| | - Huanxin Xie
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China
| | - Guixiang Shan
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China
| | - Jie Hu
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China
| | - Jubao Du
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Road, Beijing, 100053 China.
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45
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Chan SJ, Niu W, Hayakawa K, Hamanaka G, Wang X, Cheah PS, Guo S, Yu Z, Arai K, Selim MH, Kurisawa M, Spector M, Lo EH. Promoting Neuro-Supportive Properties of Astrocytes with Epidermal Growth Factor Hydrogels. Stem Cells Transl Med 2019; 8:1242-1248. [PMID: 31483567 PMCID: PMC6877762 DOI: 10.1002/sctm.19-0159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022] Open
Abstract
Biomaterials provide novel platforms to deliver stem cell and growth factor therapies for central nervous system (CNS) repair. The majority of these approaches have focused on the promotion of neural progenitor cells and neurogenesis. However, it is now increasingly recognized that glial responses are critical for recovery in the entire neurovascular unit. In this study, we investigated the cellular effects of epidermal growth factor (EGF) containing hydrogels on primary astrocyte cultures. Both EGF alone and EGF-hydrogel equally promoted astrocyte proliferation, but EGF-hydrogels further enhanced astrocyte activation, as evidenced by a significantly elevated Glial fibrillary acidic protein (GFAP) gene expression. Thereafter, conditioned media from astrocytes activated by EGF-hydrogel protected neurons against injury and promoted synaptic plasticity after oxygen-glucose deprivation. Taken together, these findings suggest that EGF-hydrogels can shift astrocytes into neuro-supportive phenotypes. Consistent with this idea, quantitative-polymerase chain reaction (qPCR) demonstrated that EGF-hydrogels shifted astrocytes in part by downregulating potentially negative A1-like genes (Fbln5 and Rt1-S3) and upregulating potentially beneficial A2-like genes (Clcf1, Tgm1, and Ptgs2). Further studies are warranted to explore the idea of using biomaterials to modify astrocyte behavior and thus indirectly augment neuroprotection and neuroplasticity in the context of stem cell and growth factor therapies for the CNS. Stem Cells Translational Medicine 2019;8:1242&1248.
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Affiliation(s)
- Su Jing Chan
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Wanting Niu
- Tissue Engineering LaboratoriesVA Boston Healthcare SystemBostonMassachusettsUSA,Department of Orthopaedic SurgeryBrigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Kazuhide Hayakawa
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Gen Hamanaka
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Xiaoying Wang
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Pike See Cheah
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA,Genetics and Regenerative Medicine Research Center, Department of Human AnatomyUniversiti PutraSerdangSelangorMalaysia
| | - Shuzhen Guo
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Zhangyang Yu
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Ken Arai
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Magdy H. Selim
- Department of NeurologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMassachusettsUSA
| | - Motoichi Kurisawa
- Institute Bioengineering and Nanotechnology, A*STARSingaporeSingapore
| | - Myron Spector
- Tissue Engineering LaboratoriesVA Boston Healthcare SystemBostonMassachusettsUSA,Department of Orthopaedic SurgeryBrigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA,Harvard‐MIT Division of Health Sciences and TechnologyMassachusetts Institute of TechnologyCambridgeMassachusettsUSA
| | - Eng H. Lo
- Neuroprotection Research Laboratory, Departments of Radiology and NeurologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
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Blöchl M, Meissner S, Nestler S. Does depression after stroke negatively influence physical disability? A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2019; 247:45-56. [PMID: 30654265 DOI: 10.1016/j.jad.2018.12.082] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/11/2018] [Accepted: 12/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depression after stroke is common and has been proposed to negatively affect disability by preventing optimal physical rehabilitation and recovery. However, the nature of this influence remains poorly understood. Here, we synthesise longitudinal studies to examine the hypotheses that depression after stroke (i) hampers physical rehabilitation, (ii) prevents functional improvement during recovery, and (iii) is associated with poor functional outcomes. METHODS A systematic literature search was conducted using the databases PubMed and Web of Science. A total of 5672 studies were screened; 28 met criteria for inclusion. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RESULTS Individual studies showed no consistent effects of depression post-stroke on (i) the effectiveness of physical rehabilitation and (ii) functional improvements during recovery. In contrast, random-effects models revealed that (iii) depression after stroke was associated with an increased risk for poor long-term disability (OR: 2.16, 95% CI 1.70-2.77). Overall, the quality of studies was moderate and there was evidence for publication bias. LIMITATIONS The number of included studies was small. There was considerable methodological heterogeneity between studies, prohibiting meta-analyses for all effects of interest. Few studies examined the influence of antidepressants. CONCLUSIONS Depressed stroke patients are generally more disabled. However, depressed mood might not restrict improvements in physical disability during rehabilitation and recovery, although it seems to be linked to a delayed increase in the risk of poor functional outcome. High-quality evidence from longitudinal studies is needed to clarify the precise mechanisms and temporal dynamics underlying these associations.
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Affiliation(s)
- Maria Blöchl
- Department for Psychology, University of Leipzig, Germany; International Max Plank Research School: Neuroscience of Communication: Structure, Function, and Plasticity, Leipzig, Germany.
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Abstract
PURPOSE OF REVIEW After decades of hype, cell-based therapies are emerging into the clinical arena for the purposes of promoting recovery after stroke. In this review, we discuss the most recent science behind the role of cell-based therapies in ischemic stroke and the efforts to translate these therapies into human clinical trials. RECENT FINDINGS Preclinical data support numerous beneficial effects of cell-based therapies in both small and large animal models of ischemic stroke. These benefits are driven by multifaceted mechanisms promoting brain repair through immunomodulation, trophic support, circuit reorganization, and cell replacement. Cell-based therapies offer tremendous potential for improving outcomes after stroke through multimodal support of brain repair. Based on recent clinical trials, cell-based therapies appear both feasible and safe in all phases of stroke. Ongoing translational research and clinical trials will further refine these therapies and have the potential to transform the approach to stroke recovery and rehabilitation.
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Affiliation(s)
- Ania Dabrowski
- Department of Neurology, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, 21287, USA
| | - Thomas J Robinson
- Department of Neurology, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, 21287, USA
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, 21287, USA.
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48
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Rajagopalan V, Natarajan M, Alex J, Solomon JM. How does context influence arm use after stroke? A qualitative content analysis among rural community-dwelling stroke survivors. Braz J Phys Ther 2018; 24:61-68. [PMID: 30501938 DOI: 10.1016/j.bjpt.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors. METHODS We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis. RESULTS Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts. CONCLUSION Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery.
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Affiliation(s)
- Vasanthan Rajagopalan
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India.
| | - Manikandan Natarajan
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Acdemy of Higher Education, Manipal, India
| | - Johnson Alex
- Department of Behavior Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - John M Solomon
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Acdemy of Higher Education, Manipal, India
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Suwanwela NC, Chen CLH, Lee CF, Young SH, Tay SS, Umapathi T, Lao AY, Gan HH, Baroque Ii AC, Navarro JC, Chang HM, Advincula JM, Muengtaweepongsa S, Chan BPL, Chua CL, Wijekoon N, de Silva HA, Hiyadan JHB, Wong KSL, Poungvarin N, Eow GB, Venketasubramanian N. Effect of Combined Treatment with MLC601 (NeuroAiDTM) and Rehabilitation on Post- Stroke Recovery: The CHIMES and CHIMES-E Studies. Cerebrovasc Dis 2018; 46:82-88. [PMID: 30184553 DOI: 10.1159/000492625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE MLC601 has been shown in preclinical studies to enhance neurorestorative mechanisms after stroke. The aim of this post hoc analysis was to assess whether combining MLC601 and rehabilitation has an effect on improving functional outcomes after stroke. METHODS Data from the CHInese Medicine NeuroAiD Efficacy on Stroke (CHIMES) and CHIMES-Extension (CHIMES-E) studies were analyzed. CHIMES-E was a 24-month follow-up study of subjects included in CHIMES, a multi-centre, double-blind placebo-controlled trial which randomized subjects with acute ischemic stroke, to either MLC601 or placebo for 3 months in addition to standard stroke treatment and rehabilitation. Subjects were stratified according to whether they received or did not receive persistent rehabilitation up to month (M)3 (non- randomized allocation) and by treatment group. The modified Rankin Scale (mRS) and Barthel Index were assessed at month (M) 3, M6, M12, M18, and M24. RESULTS Of 880 subjects in CHIMES-E, data on rehabilitation at M3 were available in 807 (91.7%, mean age 61.8 ± 11.3 years, 36% female). After adjusting for prognostic factors of poor outcome (age, sex, pre-stroke mRS, baseline National Institute of Health Stroke Scale, and stroke onset-to-study-treatment time), subjects who received persistent rehabilitation showed consistently higher treatment effect in favor of MLC601 for all time points on mRS 0-1 dichotomy analysis (ORs 1.85 at M3, 2.18 at M6, 2.42 at M12, 1.94 at M18, 1.87 at M24), mRS ordinal analysis (ORs 1.37 at M3, 1.40 at M6, 1.53 at M12, 1.50 at M18, 1.38 at M24), and BI ≥95 dichotomy analysis (ORs 1.39 at M3, 1.95 at M6, 1.56 at M12, 1.56 at M18, 1.46 at M24) compared to those who did not receive persistent rehabilitation. CONCLUSIONS More subjects on MLC601 improved to functional independence compared to placebo among subjects receiving persistent rehabilitation up to M3. The larger treatment effect of MLC601 was sustained over 2 years which supports the hypothesis that MLC601 combined with rehabilitation might have beneficial and sustained effects on neuro-repair processes after stroke. There is a need for more data on the effect of combining rehabilitation programs with stroke recovery treatments.
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Affiliation(s)
- Nijasri C Suwanwela
- Chulalongkorn University, Chulalongkorn Stroke Centre, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Christopher L H Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Chun Fan Lee
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - San San Tay
- Changi General Hospital, Singapore, Singapore
| | - Thirugnanam Umapathi
- National Neuroscience Institute, Tan Tock Seng Hospital Campus, Singapore, Singapore
| | | | - Herminigildo H Gan
- Jose Reyes Memorial Medical Center, San Lazaro Compound, Manila, Philippines
| | | | - Jose C Navarro
- Jose R Reyes Medical Center, Neuroscience Institute St Luke's Medical Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore
| | - Joel M Advincula
- West Visayas State University Medical Center, Iloilo, Philippines
| | | | - Bernard P L Chan
- National University Hospital, National University Health System, Singapore, Singapore
| | - Carlos L Chua
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | - H Asita de Silva
- Clinical Trials Unit, Faculty of Medicine, University of Kelaniya, Annasihena Road, Ragama, Sri Lanka
| | | | | | | | - Gaik Bee Eow
- Penang Hospital, Jalan Residensi, George Town, Malaysia
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50
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George PM, Oh B, Dewi R, Hua T, Cai L, Levinson A, Liang X, Krajina BA, Bliss TM, Heilshorn SC, Steinberg GK. Engineered stem cell mimics to enhance stroke recovery. Biomaterials 2018; 178:63-72. [PMID: 29909038 DOI: 10.1016/j.biomaterials.2018.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
Currently, no medical therapies exist to augment stroke recovery. Stem cells are an intriguing treatment option being evaluated, but cell-based therapies have several challenges including developing a stable cell product with long term reproducibility. Since much of the improvement observed from cellular therapeutics is believed to result from trophic factors the stem cells release over time, biomaterials are well-positioned to deliver these important molecules in a similar fashion. Here we show that essential trophic factors secreted from stem cells can be effectively released from a multi-component hydrogel system into the post-stroke environment. Using our polymeric system to deliver VEGF-A and MMP-9, we improved recovery after stroke to an equivalent degree as observed with traditional stem cell treatment in a rodent model. While VEGF-A and MMP-9 have many unique mechanisms of action, connective tissue growth factor (CTGF) interacts with both VEGF-A and MMP-9. With our hydrogel system as well as with stem cell delivery, the CTGF pathway is shown to be downregulated with improved stroke recovery.
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Affiliation(s)
- Paul M George
- Department of Neurology and the Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA; Stanford Stroke Center and Stanford University School of Medicine, Stanford, CA, USA.
| | - Byeongtaek Oh
- Department of Neurology and the Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruby Dewi
- Department of Material Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Thuy Hua
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lei Cai
- Department of Material Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexa Levinson
- Department of Neurology and the Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Xibin Liang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Brad A Krajina
- Department of Material Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Tonya M Bliss
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah C Heilshorn
- Department of Material Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary K Steinberg
- Department of Neurology and the Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA; Stanford Stroke Center and Stanford University School of Medicine, Stanford, CA, USA.
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