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Variability in stroke motor outcome is explained by structural and functional integrity of the motor system.

ABSTRACT: Biomarkers that represent the structural and functional integrity of the motor system enable us to better assess motor outcome post-stroke. The degree of overlap between the stroke lesion and corticospinal tract (CST Injury) is a measure of the structural integrity of the motor system, whereas the left-to-right motor cortex resting state connectivity (LM1-RM1 rs-connectivity) is a measure of its functional integrity. CST Injury and LM1-RM1 rs-connectivity each individually correlate with motor outcome post-stroke, but less is understood about the relationship between these biomarkers. Thus, this study investigates the relationship between CST Injury and LM1-RM1 rs-connectivity, individually and together, with motor outcome. Twenty-seven participants with upper limb motor deficits post-stroke completed motor assessments and underwent MRI at one time point. CST Injury and LM1-RM1 rs-connectivity were derived from T1-weighted and resting state functional MRI scans, respectively. We performed hierarchical multiple regression analyses to determine the contribution of each biomarker in explaining motor outcome. The interaction between CST Injury and LM1-RM1 rs-connectivity does not significantly contribute to the variability in motor outcome. However, inclusion of both CST Injury and LM1-RM1 rs-connectivity explains more variability in motor outcome, than either alone. We suggest both biomarkers provide distinct information about an individual's motor outcome.

SUBMITTER: Lam TK

PROVIDER: S-EPMC6013462 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Variability in stroke motor outcome is explained by structural and functional integrity of the motor system.

Lam Timothy K TK Binns Malcolm A MA Honjo Kie K Dawson Deirdre R DR Ross Bernhard B Stuss Donald T DT Black Sandra E SE Chen J Jean JJ Fujioka Takako T Chen Joyce L JL

Scientific reports 20180621 1

Biomarkers that represent the structural and functional integrity of the motor system enable us to better assess motor outcome post-stroke. The degree of overlap between the stroke lesion and corticospinal tract (CST Injury) is a measure of the structural integrity of the motor system, whereas the left-to-right motor cortex resting state connectivity (LM1-RM1 rs-connectivity) is a measure of its functional integrity. CST Injury and LM1-RM1 rs-connectivity each individually correlate with motor o ...[more]

PMID: 29930399

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Project description:Previous studies investigating brain activation present during upper limb movement after stroke have greatly detailed activity alterations in the ipsi- and contralesional primary motor cortices (M1). Despite considerable interest in M1, investigations into the integration and coordination of large-scale functional networks subserving motor, sensory, and cognitive control after stroke remain scarce. The purpose of this study was to assess non-static functional connectivity within whole-brain networks involved in the production of isometric, visually-paced hand grips. Seventeen stroke patients and 24 healthy controls underwent functional MRI while performing a series of 50 isometric hand grips with their affected hand (stroke patients) or dominant hand (control subjects). We used task-based multivariate functional connectivity to derive spatial and temporal information of whole-brain networks specifically underlying hand movement. This technique has the advantage of extracting within-network commonalities across groups and identifying connectivity differences between these groups. We further used a nonparametric statistical approach to identify group differences in regional activity within these task-specific networks and assess whether such alterations were related to the degree of motor impairment in stroke patients. Our whole-brain multivariate analysis revealed group differences in two networks: (1) a motor network, including pre- and postcentral gyri, dorsal and ventral premotor cortices, as well as supplementary motor area, in which stroke patients showed reduced task-related activation compared to controls, and (2) a default-mode network (DMN), including the posterior cingulate cortex, precuneus, and medial prefrontal cortex, in which patients showed less deactivation than controls. Within-network group differences revealed decreased activity in ipsilesional primary sensorimotor cortex in stroke patients, which also positively correlated with lower levels of motor impairment. Moreover, the temporal information extracted from the functional networks revealed that stroke patients did not show a reciprocal DMN deactivation peak following activation of their motor network. This finding suggests that allocation of functional resources to motor areas during hand movement may impair their ability to efficiently switch from one network to another. Taken together, our study expands our understanding of functional reorganization during motor recovery after a stroke, and suggests that modulation of ipsilesional sensorimotor activity may increase the integrity of a whole-brain motor network, contribute to better motor performance, and optimize network flexibility.

Project description:ObjectiveStudies on upper limb recovery following stroke have highlighted the importance of the structural and functional integrity of the corticospinal tract (CST) in determining clinical outcomes. However, such relationships have not been fully explored for the lower limb. We aimed to test whether variation in walking impairment was associated with variation in the structural or functional integrity of the CST.MethodsTranscranial magnetic stimulation was used to stimulate each motor cortex while EMG recordings were taken from the vastus lateralis (VL) bilaterally; these EMG measures were used to calculate both ipsilateral and contralateral recruitment curves for each lower limb. The slope of these recruitment curves was used to examine the strength of functional connectivity from the motor cortex in each hemisphere to the lower limbs in chronic stroke patients and to calculate a ratio between ipsilateral and contralateral outputs referred to as the functional connectivity ratio (FCR). The structural integrity of the CST was assessed using diffusion tensor MRI to measure the asymmetry in fractional anisotropy (FA) of the internal capsule. Lower limb impairment and walking speed were also measured.ResultsThe FCR for the paretic leg correlated with walking impairment, such that greater relative ipsilateral connectivity was associated with slower walking speeds. Asymmetrical FA values, reflecting reduced structural integrity of the lesioned CST, were associated with greater walking impairment. FCR and FA asymmetry were strongly positively correlated with each other.ConclusionsPatients with relatively greater ipsilateral connectivity between the contralesional motor cortex and the paretic lower limb were more behaviorally impaired and had more structural damage to their ipsilesional hemisphere CST.SignificanceMeasures of structural and functional damage may be useful in the selection of therapeutic strategies, allowing for more tailored and potentially more beneficial treatments.

Dataset Information

Variability in stroke motor outcome is explained by structural and functional integrity of the motor system.

Publications

Variability in stroke motor outcome is explained by structural and functional integrity of the motor system.

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