Anatomy of stroke injury predicts gains from therapy.
Anatomy of stroke injury predicts gains from therapy.
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DOI：
10.1161/strokeaha.110.599340
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发表时间：
2011-02
期刊：
影响因子：
8.3
通讯作者：
Cramer SC
中科院分区：
文献类型：
--
作者：
Riley JD;Le V;Der-Yeghiaian L;See J;Newton JM;Ward NS;Cramer SC
许多旨在改善中风患者运动功能的疗法正在出现。确定治疗收益所需的关键生物基质将有助于预测治疗效果，并最大限度地提高治疗效果。目前的研究提出了一个假设，即通过关键运动系统白色物质束的结构完整性预测针对上肢远端的治疗的行为增益。23例慢性左侧卒中受试者接受了针对右上肢远端的机器人治疗。在基线时获得MRI并用于勾画梗死。对于每一个受试者，中风损伤的程度的四个下降的白色物质束（从初级运动皮层，辅助运动区，背侧运动前皮层，腹侧运动前皮层，分别）进行了测定。然后研究了特定的神经束损伤和治疗获得的行为之间的相关性。许多例子被发现，从而特定的道损伤预测治疗收益。与脑卒中损伤的相关性最强的是初级运动皮层和背侧运动前皮层的下行神经束。CT容积和基线行为是治疗获益的弱预测因子。特定运动神经束损伤程度可预测慢性卒中患者治疗后的行为改善。这支持了这些纤维束在介导治疗效果中的作用，并加强了卒中中病变位置的重要性。在预测增益方面，特定的脑束损伤比梗死体积或基线临床状态更强，识别具有足够生物基质的受试者以从治疗中改善，因此可能在基于修复的试验中作为进入标准是有用的。
Many therapies are emerging that aim to improve motor function in people with stroke. Identifying key biological substrates needed for treatment gains would help to predict treatment effects, and to maximize treatment impact. The current study addressed the hypothesis that behavioral gains from therapy targeting distal upper extremity are predicted by the structural integrity of key motor system white matter tracts. Twenty three subjects with chronic left-sided stroke underwent robotic therapy targeting the distal right upper extremity. MRI was obtained at baseline and used to outline the infarct. For each subject, the degree to which stroke injured each of four descending white matter tracts (from primary motor cortex, supplementary motor area, dorsal premotor cortex, and ventral premotor cortex, respectively) was determined. Correlations between tract-specific injury and behavioral gains from therapy were then examined. Numerous examples were found whereby tract-specific injury predicted treatment gains. The strongest correlations related to stroke injury to tracts descending from primary motor cortex and dorsal premotor cortex. Infarct volume and baseline behavior were weak predictors of treatment gains. Extent of injury to specific motor tracts predicts behavioral gains from treatment in subjects with chronic stroke. This supports a role for these tracts in mediating treatment effects, and reinforces the importance of lesion location in stroke. Tract-specific injury was stronger than infarct volume or baseline clinical status at predicting gains, identifies subjects with sufficient biological substrate to improve from therapy, and so might be useful as an entry criterion in repair-based trials.