Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation.

Abstract:

BACKGROUND AND PURPOSE:The goal of this study was to characterize cortical reorganization after stroke and its relation with the site of the stroke-induced lesion and degree of motor recovery using functional MRI (fMRI). METHODS:Fourteen stroke patients with an affected upper limb were studied longitudinally. Three fMRI sessions were performed over a period of 1 to 6 months after stroke. Upper limb recovery, Wallerian degeneration of the pyramidal tract, and responses to transcranial magnetic stimulation were assessed. RESULTS:Two main patterns of cortical reorganization were found. Pattern 1 was focusing, in which, after initial recruitment of additional ipsilateral and contralateral areas, activation gradually developed toward a pattern of activation restricted to the contralateral sensorimotor cortex in 9 patients. Five patients were found to have pattern 2, persistent recruitment, in which there was an initial and sustained recruitment of ipsilateral activity. Occurrence of recruitment or focusing seemed to depend mainly on whether the primary motor cortex (M1) was lesioned; persistent recruitment was observed in 3 of 4 patients with M1 injury, and focusing was seen in 8 of 10 patients with spared M1. These patterns had no relation to the degree of recovery; in particular, focusing did not imply recovery. However, there was a clear relation between the degree of recovery and the degree of Wallerian degeneration. CONCLUSIONS:These results suggest that ipsilateral recruitment after stroke corresponds to a compensatory corticocortical process related to the lesion of the contralateral M1 and that the process of compensatory recruitment will persist if M1 is lesioned; otherwise, it will be transient.

journal_name

Stroke

journal_title

Stroke

authors

Feydy A,Carlier R,Roby-Brami A,Bussel B,Cazalis F,Pierot L,Burnod Y,Maier MA

doi

10.1161/01.str.0000017100.68294.52

subject

Has Abstract

pub_date

2002-06-01 00:00:00

pages

1610-7

issue

6

eissn

0039-2499

issn

1524-4628

journal_volume

33

pub_type

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