Longitudinal Structural and Functional Differences Between Proportional and Poor Motor Recovery After Stroke
Longitudinal Structural and Functional Differences Between Proportional and Poor Motor Recovery After Stroke
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DOI：
10.1177/1545968317740634
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发表时间：
2017-12-01
影响因子：
4.2
通讯作者：
Buch, Ethan R.
中科院分区：
文献类型：
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作者：
Guggisberg, Adrian G.;Nicolo, Pierre;Buch, Ethan R.
背景在中风后的第一个月期间，运动功能的演变通常分为两类，包括恢复到最大可能改善的约70%（成比例恢复，PROP）或几乎没有改善（“恢复差，POOR”）。目前没有证据表明任何康复治疗将预防POOR并有利于PROP。进行纵向和多模式评估的功能和结构变化的大脑组织与PROP。在卒中发作后2周和4周（T0）以及3个月（T1），对63例患者进行上肢Fugl-Meyer评估和高密度脑电图（EEG），对46例患者进行弥散张量成像。结果我们确认了样品中存在2种不同的回收模式（PROP和POOR）。在T0时，PROP患者皮质脊髓束（CST）的完整性更高，受累半球与大脑其余部分之间的EEG功能连接性（FC）更高，特别是腹侧运动前区与初级运动皮质之间。POOR患者在T0和T1之间患侧半球皮质和离皮质纤维束退化，而PROP患者未观察到。更好的初始CST完整性与更大的初始全局FC相关，这反过来又与T0和T1之间更少的白色物质降解相关。结论.这些研究结果表明，初始CST的完整性，系统水平的皮质网络可塑性，减少白色物质萎缩，中风后的临床运动恢复之间的联系。这识别候选治疗目标。
Background. Evolution of motor function during the first months after stroke is stereotypically bifurcated, consisting of either recovery to about 70% of maximum possible improvement (proportional recovery, PROP") or in little to no improvement ("poor recovery, POOR"). There is currently no evidence that any rehabilitation treatment will prevent POOR and favor PROP. Objective. To perform a longitudinal and multimodal assessment of functional and structural changes in brain organization associated with PROP. Methods. Fugl-Meyer Assessments of the upper extremity and high-density electroencephalography (EEG) were obtained from 63 patients, diffusion tensor imaging from 46 patients, at 2 and 4 weeks (T0) and at 3 months (T1) after stroke onset. Results. We confirmed the presence of 2 distinct recovery patterns (PROP and POOR) in our sample. At T0, PROP patients had greater integrity of the corticospinal tract (CST) and greater EEG functional connectivity (FC) between the affected hemisphere and rest of the brain, in particular between the ventral premotor and the primary motor cortex. POOR patients suffered from degradation of corticocortical and corticofugal fiber tracts in the affected hemisphere between T0 and T1, which was not observed in PROP patients. Better initial CST integrity correlated with greater initial global FC, which was in turn associated with less white matter degradation between T0 and T1. Conclusions. These findings suggest links between initial CST integrity, systems-level cortical network plasticity, reduction of white matter atrophy, and clinical motor recovery after stroke. This identifies candidate treatment targets.