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(Stroke. 2005;36:e50.)
© 2005 American Heart Association, Inc.

Short Communications

Use of Functional MRI to Guide Decisions in a Clinical Stroke Trial

Steven C. Cramer, MD; Randall R. Benson, MD; David M. Himes, BS; Vijaya C. Burra, MS; Jeri S. Janowsky, PhD; Martin E. Weinand, MD; Jeffrey A. Brown, MD Helmi L. Lutsep, MD

From the University of California (S.C.C.), Irvine, Calif and the UCI Medical Center, Orange, Calif; Wayne State University (R.R.B., V.C.B., J.A.B.), Detroit, Mich, and the Department of Neurology-UHC 8D, Detroit, Mich; Northstar Neuroscience, Inc (D.M.H.), Seattle, Wash; the Oregon Health & Science University (J.S.J., H.L.L.), Portland, Ore; and the University of Arizona (M.E.W.), Tucson, Ariz.

Correspondence to Steven C. Cramer, MD, UCI Medical Center, 101 The City Drive South, Building 53 Room 203, Orange, CA 92868-4280. E-mail scramer{at}uci.edu

Background and Purpose— An investigational trial examined safety and efficacy of targeted subthreshold cortical stimulation in patients with chronic stroke. The anatomical location for the target, hand motor area, varies across subjects, and so was localized with functional MRI (fMRI). This report describes the experience of incorporating standardized fMRI into a multisite stroke trial.

Methods— At 3 enrollment centers, patients moved (0.25 Hz) the affected hand during fMRI. Hand motor function was localized at a fourth center guiding intervention for those randomized to stimulation.

Results— The fMRI results were available within 24 hours. Across 12 patients, activation site variability was substantial (12, 23, and 11 mm in x, y, and z directions), exceeding stimulating electrode dimensions.

Conclusion— Use of fMRI to guide decision-making in a clinical stroke trial is feasible.

Key Words: magnetic resonance imaging • motor activity • neuronal plasticity • stroke

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