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(Stroke. 1997;28:2518-2527.)
© 1997 American Heart Association, Inc.
Articles |
A Functional MRI Study of Subjects Recovered From Hemiparetic Stroke
From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (S.C.C., G.N., J.D.K., D.N.K., S.P.F.); The Neurorecovery Program, Massachusetts General Hospital and Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Mass (S.C.C., G.N., J.D.K., S.A.F.); The Clinical Investigator Training Program, Harvard-MIT Division of Health Sciences and Technology and Beth Israel-Deaconess Medical Center in collaboration with Pfizer Inc. (S.C.C.); The MGH-NMR Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (S.C.C., R.R.B., K.K.K., D.N.K., B.R.R.); Biometrics Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (R.A.P.); The Center for Morphometric Analysis, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (D.N.K.); and Department of Neurology, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Mass (G.N., J.D.K.).
Correspondence to Steven C. Cramer, MD, VA Medical Center, Department of Neurology (127), 1660 S Columbian Way, Seattle, WA 98108. E-mail cramers{at}uwashington.edu
Background and Purpose Stroke recovery mechanisms remain incompletely understood, particularly for subjects with cortical stroke, in whom limited data are available. We used functional magnetic resonance imaging to compare brain activations in normal controls and subjects who recovered from hemiparetic stroke.
Methods Functional magnetic resonance imaging was performed in ten stroke subjects with good recovery, five with deep, and five with cortical infarcts. Brain activation was achieved by index finger-tapping. Statistical parametric activation maps were obtained using a t test and a threshold of P<.001. In five bilateral motor regions, the volume of activated brain for each stroke subject was compared with the distribution of activation volumes among nine controls.
Results Control subjects activated several motor regions.
During recovered hand finger-tapping, stroke subjects activated
the same regions as controls, often in a larger brain volume. In the
unaffected hemisphere, sensorimotor cortex activation was increased in
six of nine stroke subjects compared with controls. Cerebellar
hemisphere contralateral and premotor cortex ipsilateral to this
region, as well as supplementary motor areas, also had increased
activation. In the stroke hemisphere, activation exceeding controls was
uncommon, except that three of five cortical strokes showed
peri-infarct activation foci. During unaffected hand finger-tapping,
increased activation by stroke subjects compared with controls was
uncommon; however, decreased activation was seen in unaffected
sensorimotor cortex, suggesting that this region's responsiveness
increased to the ipsilateral hand and decreased to contralateral hand
movements. Use of a different threshold for defining activation
(P<.01) did not change the overall findings (
=.75).
Conclusions Recovered finger-tapping by stroke subjects activated the same motor regions as controls but to a larger extent, particularly in the unaffected hemisphere. Increased reliance on these motor areas may represent an important component of motor recovery. Functional magnetic resonance imaging studies of subjects who recovered from stroke provide evidence for several processes that may be related to restoration of neurologic function.
Key Words: stroke outcome • magnetic resonance imaging • motor activity
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V. Di Piero, S. Di Legge, M. Altieri, G. L. Lenzi, R. M. Lazar, R. S. Marshall, and J.P. Mohr When Is a Stroke Actually "Stable"? * Response Stroke, June 1, 2002; 33(6): 1456 - 1457. [Full Text] [PDF]
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A. Feydy, R. Carlier, A. Roby-Brami, B. Bussel, F. Cazalis, L. Pierot, Y. Burnod, and M.A. Maier Longitudinal Study of Motor Recovery After Stroke: Recruitment and Focusing of Brain Activation Stroke, June 1, 2002; 33(6): 1610 - 1617. [Abstract] [Full Text] [PDF]
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J. R. Carey, T. J. Kimberley, S. M. Lewis, E. J. Auerbach, L. Dorsey, P. Rundquist, and K. Ugurbil Analysis of fMRI and finger tracking training in subjects with chronic stroke Brain, April 1, 2002; 125(4): 773 - 788. [Abstract] [Full Text] [PDF]
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M. A. Rocca, P. M. Matthews, D. Caputo, A. Ghezzi, A. Falini, G. Scotti, G. Comi, and M. Filippi Evidence for widespread movement-associated functional MRI changes in patients with PPMS Neurology, March 26, 2002; 58(6): 866 - 872. [Abstract] [Full Text] [PDF]
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T. Krings, R. Topper, K. Willmes, M. H.T. Reinges, J. M. Gilsbach, and A. Thron Activation in primary and secondary motor areas in patients with CNS neoplasms and weakness Neurology, February 12, 2002; 58(3): 381 - 390. [Abstract] [Full Text] [PDF]
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H Reddy, D Bendahan, M A Lee, H Johansen-Berg, M Donaghy, D Hilton-Jones, and P M Matthews An expanded cortical representation for hand movement after peripheral motor denervation J. Neurol. Neurosurg. Psychiatry, February 1, 2002; 72(2): 203 - 210. [Abstract] [Full Text] [PDF]
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H. Reddy, N. De Stefano, M. Mortilla, A. Federico, and P. M. Matthews Functional Reorganization of Motor Cortex Increases With Greater Axonal Injury From CADASIL Stroke, February 1, 2002; 33(2): 502 - 508. [Abstract] [Full Text] [PDF]
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R. Pineiro, S. Pendlebury, H. Johansen-Berg, and P.M. Matthews Altered Hemodynamic Responses in Patients After Subcortical Stroke Measured by Functional MRI Stroke, January 1, 2002; 33(1): 103 - 109. [Abstract] [Full Text] [PDF]
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 S C Cramer, E Fray, A Tievsky, R A Parker, P N Riskind, M C Stein, V Wedeen, and B R Rosen Changes in motor cortex activation after recovery from spinal cord inflammation Multiple Sclerosis, December 1, 2001; 7(6): 364 - 370. [Abstract] [PDF]
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S. Ohara, T. Mima, K. Baba, A. Ikeda, T. Kunieda, R. Matsumoto, J. Yamamoto, M. Matsuhashi, T. Nagamine, K. Hirasawa, et al. Increased Synchronization of Cortical Oscillatory Activities between Human Supplementary Motor and Primary Sensorimotor Areas during Voluntary Movements J. Neurosci., December 1, 2001; 21(23): 9377 - 9386. [Abstract] [Full Text] [PDF]
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C. Calautti, F. Leroy, J.-Y. Guincestre, and J.-C. Baron Dynamics of Motor Network Overactivation After Striatocapsular Stroke: A Longitudinal PET Study Using a Fixed-Performance Paradigm Stroke, November 1, 2001; 32(11): 2534 - 2542. [Abstract] [Full Text] [PDF]
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T. Mima, K. Toma, B. Koshy, and M. Hallett Coherence Between Cortical and Muscular Activities After Subcortical Stroke Stroke, November 1, 2001; 32(11): 2597 - 2601. [Abstract] [Full Text] [PDF]
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R. M. Dijkhuizen, J. Ren, J. B. Mandeville, O. Wu, F. M. Ozdag, M. A. Moskowitz, B. R. Rosen, and S. P. Finklestein Functional magnetic resonance imaging of reorganization in rat brain after stroke PNAS, October 12, 2001; (2001) 231235598. [Abstract] [Full Text] [PDF]
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M. Kobayashi, H. Takayama, S. Suga, B. Mihara, G. A. Rosenberg, and W. M. Brooks Longitudinal Changes of Metabolites in Frontal Lobes After Hemorrhagic Stroke of Basal Ganglia: A Proton Magnetic Resonance Spectroscopy Study Editorial Comment: A Proton Magnetic Resonance Spectroscopy Study Stroke, October 1, 2001; 32(10): 2237 - 2245. [Abstract] [Full Text] [PDF]
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J. Biernaskie and D. Corbett Enriched Rehabilitative Training Promotes Improved Forelimb Motor Function and Enhanced Dendritic Growth after Focal Ischemic Injury J. Neurosci., July 15, 2001; 21(14): 5272 - 5280. [Abstract] [Full Text] [PDF]
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R. Pineiro, S. Pendlebury, H. Johansen-Berg, and P. M. Matthews Functional MRI Detects Posterior Shifts in Primary Sensorimotor Cortex Activation After Stroke : Evidence of Local Adaptive Reorganization? Stroke, May 1, 2001; 32(5): 1134 - 1139. [Abstract] [Full Text] [PDF]
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T. Veizovic, J. S. Beech, R. P. Stroemer, W. P. Watson, and H. Hodges Resolution of Stroke Deficits Following Contralateral Grafts of Conditionally Immortal Neuroepithelial Stem Cells Stroke, April 1, 2001; 32(4): 1012 - 1019. [Abstract] [Full Text] [PDF]
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J. A. Detre and T. F. Floyd Functional MRI and Its Applications to the Clinical Neurosciences Neuroscientist, February 1, 2001; 7(1): 64 - 79. [Abstract] [PDF]
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S. C. Cramer, G. Nelles, J. D. Schaechter, J. D. Kaplan, S. P. Finklestein, and B. R. Rosen A Functional MRI Study of Three Motor Tasks in the Evaluation of Stroke Recovery Neurorehabil Neural Repair, January 1, 2001; 15(1): 1 - 8. [Abstract] [PDF]
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T. Platz, I. H. Kim, H. Pintschovius, T. Winter, A. Kieselbach, K. Villringer, R. Kurth, and K.-H. Mauritz Multimodal EEG analysis in man suggests impairment-specific changes in movement-related electric brain activity after stroke Brain, December 1, 2000; 123(12): 2475 - 2490. [Abstract] [Full Text] [PDF]
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H. Reddy, S. Narayanan, R. Arnoutelis, M. Jenkinson, J. Antel, P. M. Matthews, and D. L. Arnold Evidence for adaptive functional changes in the cerebral cortex with axonal injury from multiple sclerosis Brain, November 1, 2000; 123(11): 2314 - 2320. [Abstract] [Full Text] [PDF]
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F E Roux, K Boulanouar, D Ibarrola, M Tremoulet, F Chollet, and I Berry Functional MRI and intraoperative brain mapping to evaluate brain plasticity in patients with brain tumours and hemiparesis J. Neurol. Neurosurg. Psychiatry, October 1, 2000; 69(4): 453 - 463. [Abstract] [Full Text] [PDF]
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J. Kessler, A. Thiel, H. Karbe, and W. D. Heiss Piracetam Improves Activated Blood Flow and Facilitates Rehabilitation of Poststroke Aphasic Patients Stroke, September 1, 2000; 31(9): 2112 - 2116. [Abstract] [Full Text] [PDF]
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