scholarly journals Brain responsivity provides an individual readout for motor recovery after stroke

Brain ◽  
2020 ◽  
Vol 143 (6) ◽  
pp. 1873-1888 ◽  
Author(s):  
Caroline Tscherpel ◽  
Sebastian Dern ◽  
Lukas Hensel ◽  
Ulf Ziemann ◽  
Gereon R Fink ◽  
...  
Keyword(s):  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Recovery Of Function ◽  
Motor Recovery ◽  
Motor Deficit ◽  
Individual Response ◽  
Stroke Patients ◽  
Time Frequency ◽  
Post Stroke ◽  
Stroke Research

Abstract Promoting the recovery of motor function and optimizing rehabilitation strategies for stroke patients is closely associated with the challenge of individual prediction. To date, stroke research has identified critical pathophysiological neural underpinnings at the cellular level as well as with regard to network reorganization. However, in order to generate reliable readouts at the level of individual patients and thereby realize translation from bench to bedside, we are still in a need for innovative methods. The combined use of transcranial magnetic stimulation (TMS) and EEG has proven powerful to record both local and network responses at an individual’s level. To elucidate the potential of TMS-EEG to assess motor recovery after stroke, we used neuronavigated TMS-EEG over ipsilesional primary motor cortex (M1) in 28 stroke patients in the first days after stroke. Twenty-five of these patients were reassessed after >3 months post-stroke. In the early post-stroke phase (6.7 ± 2.5 days), the TMS-evoked EEG responses featured two markedly different response morphologies upon TMS to ipsilesional M1. In the first group of patients, TMS elicited a differentiated and sustained EEG response with a series of deflections sequentially involving both hemispheres. This response type resembled the patterns of bilateral activation as observed in the healthy comparison group. By contrast, in a subgroup of severely affected patients, TMS evoked a slow and simplified local response. Quantifying the TMS-EEG responses in the time and time-frequency domain revealed that stroke patients exhibited slower and simple responses with higher amplitudes compared to healthy controls. Importantly, these patterns of activity changes after stroke were not only linked to the initial motor deficit, but also to motor recovery after >3 months post-stroke. Thus, the data revealed a substantial impairment of local effects as well as causal interactions within the motor network early after stroke. Additionally, for severely affected patients with absent motor evoked potentials and identical clinical phenotype, TMS-EEG provided differential response patterns indicative of the individual potential for recovery of function. Thereby, TMS-EEG extends the methodological repertoire in stroke research by allowing the assessment of individual response profiles.

scholarly journals Effect of opposing needling on motor cortex excitability in healthy participants and in patients with post-stroke hemiplegia: study protocol for a single-blind, randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mindong Xu ◽  
Yinyu Zi ◽  
Jianlu Wu ◽  
Nenggui Xu ◽  
Liming Lu ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Post Stroke ◽  
Motor Cortex Excitability ◽  
Opposing Needling ◽  
Single Blind ◽  
Healthy Participants

Abstract Background Opposing needling has an obvious curative effect in the treatment of post-stroke hemiplegia; however, the mechanism of the opposing needling in the treatment of post-stroke hemiplegia is still not clear. The purpose of this study is to investigate the effect of opposing needling on the excitability of primary motor cortex (M1) of healthy participants and patients with post-stroke hemiplegia, which may provide insight into the mechanisms of opposing needling in treating post-stroke hemiplegia. Methods This will be a single-blind, randomised, sham-controlled trial in which 80 healthy participants and 40 patients with post-stroke hemiplegia will be recruited. Healthy participants will be randomised 1:1:1:1 to the 2-Hz, 50-Hz, 100-Hz, and sham electroacupuncture groups. Patients with post-stroke hemiplegia will be randomised 1:1 to the opposing needling or conventional treatment groups. The M1 will be located in all groups by using neuroimaging-based navigation. The stimulator coil of transcranial magnetic stimulation (TMS) will be moved over the left and right M1 in order to identify the TMS hotspot, followed by a recording of resting motor thresholds (RMTs) and motor-evoked potentials (MEPs) of the thenar muscles induced by TMS before and after the intervention. The primary outcome measure will be the percent change in the RMTs of the thenar muscles at baseline and after the intervention. The secondary outcome measures will be the amplitude (μV) and latency (ms) of the MEPs of the thenar muscles at baseline and after the intervention. Discussion The aim of this trial is to explore the effect of opposing needling on the excitability of M1 of healthy participants and patients with post-stroke hemiplegia. Trial registration Chinese Clinical Trial Registry ChiCTR1900028138. Registered on 13 December 2019.

Predicting Hand Motor Recovery in Severe Stroke: The Role of Motor Evoked Potentials in Relation to Early Clinical Assessment

2008 ◽  
Vol 23 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Annette A. van Kuijk ◽  
Jaco W. Pasman ◽  
Henk T. Hendricks ◽  
Machiel J. Zwarts ◽  
Alexander C. H. Geurts
Keyword(s):  
Lower Extremity ◽  
Evoked Potentials ◽  
Upper Extremity ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Motor Evoked Potentials ◽  
Motor Recovery ◽  
Stroke Patients ◽  
Abductor Digiti Minimi

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.

scholarly journals Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016566
Author(s):  
Eline C C van Lieshout ◽  
Johanna M A Visser-Meily ◽  
Sebastiaan F W Neggers ◽  
H Bart van der Worp ◽  
Rick M Dijkhuizen
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Primary Outcome ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

Benefits of antidepressant treatment after a stroke

2017 ◽  
Vol 41 (S1) ◽  
pp. S315-S315 ◽  
Author(s):  
O. Zerriaa ◽  
O. Moula ◽  
S. Ben Saadi ◽  
I. Jelalia ◽  
R. Ghachem
Keyword(s):  
Functional Recovery ◽  
Cognitive Skills ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Antidepressant Therapy ◽  
Motor Deficit ◽  
Stroke Patients ◽  
Double Blind ◽  
Post Stroke ◽  
Post Stroke Depression

IntroductionStroke is an important cause of morbidity and is responsible for 9% of all deaths worldwide. The most frequent neuropsychiatric consequence of stroke is post-stroke depression (PSD). It has been shown to be associated with both impaired recovery and increased mortality. The aim of our study is to determine the benefits of antidepressant prescription after a stroke.MethodThe databases from Medline and PubMed were reviewed for articles related to post-stroke depression (PSD), antidepressant treatment and stroke, post-stroke depression and functional recovery, stroke related impairment.ResultsAntidepressant drugs have been shown to be effective in treating PSD in six double blind randomized studies. Patients treated with antidepressants had better recovery from disability than patients who did not receive antidepressant therapy: it was proved that antidepressant drugs cause an improvement in cognitive skills and functional recovery in PSD patients. In patients with ischemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Some studies showed that PSD can be effectively prevented: nortriptyline, fluoxetine, milnacipran and sertraline appeared to be efficacious in preventing depression after stroke and are to use without significant adverse effects in stroke patients.ConclusionAntidepressant treatment plays an increasing role in the management of patients with acute stroke. Therefore, early initiation of antidepressant therapy, in non-depressed stroke patients, may reduce the odds for development of PSD, and improve cognitive and functional recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Ana Dionísio ◽  
Rita Gouveia ◽  
João Castelhano ◽  
Isabel Catarina Duarte ◽  
Gustavo C. Santo ◽  
...  
Keyword(s):  
Motor Function ◽  
Primary Motor Cortex ◽  
Phase Iii ◽  
Repeated Measure ◽  
Controlled Study ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Theta Burst

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

The Influence of Cortico-Cerebellar Structural Connectivity on Cortical Excitability in Chronic Stroke

2019 ◽  
Vol 30 (3) ◽  
pp. 1330-1344
Author(s):  
Stephanie Guder ◽  
Benedikt M Frey ◽  
Winifried Backhaus ◽  
Hanna Braass ◽  
Jan E Timmermann ◽  
...  
Keyword(s):  
Primary Motor Cortex ◽  
Structural Integrity ◽  
Cortical Excitability ◽  
Structural Information ◽  
Motor Evoked Potentials ◽  
Structural Connectivity ◽  
Chronic Stroke ◽  
Motor Output ◽  
Healthy Controls ◽  
Stroke Patients

Abstract Brain imaging has recently evidenced that the structural state of distinct reciprocal cortico-cerebellar fiber tracts, the dentato-thalamo-cortical tract (DTCT), and the cortico-ponto-cerebellar tract (CPCeT), significantly influences residual motor output in chronic stroke patients, independent from the level of damage to the corticospinal tract (CST). Whether such structural information might also directly relate to measures of cortical excitability is an open question. Eighteen chronic stroke patients with supratentorial ischemic lesions and 17 healthy controls underwent transcranial magnetic stimulation to assess recruitment curves of motor evoked potentials of both hemispheres. Diffusion-weighted imaging and probabilistic tractography were applied to reconstruct reciprocal cortico-cerebellar motor tracts between the primary motor cortex and the cerebellum. Tract-related microstructure was estimated by means of fractional anisotropy, and linear regression modeling was used to relate it to cortical excitability. The main finding was a significant association between cortical excitability and the structural integrity of the DTCT, the main cerebellar outflow tract, independent from the level of damage to the CST. A comparable relationship was neither detectable for the CPCeT nor for the healthy controls. This finding contributes to a mechanistic understanding of the putative supportive role of the cerebellum for residual motor output by facilitating cortical excitability after stroke.

Abstract TMP31: Peripheral Nerve Stimulation Paired with Constraint-Induced Therapy to Enhance Post-Stroke Upper Extremity Motor Performance

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Cheryl Carrico ◽  
KC Chelette ◽  
Laurie Nichols ◽  
Lumy Sawaki
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Motor Function ◽  
Nerve Stimulation ◽  
Motor Performance ◽  
Motor Recovery ◽  
Peripheral Nerve Stimulation ◽  
Motor Deficit ◽  
Motor Training ◽  
Post Stroke

Research has shown that peripheral nerve stimulation (PNS) can enhance motor learning following cortical lesions. Studies have also shown that intensive upper extremity motor training can significantly enhance post-stroke motor performance. Constraint-induced therapy (CIT) is a form of intensive training that restricts use of the non-paretic upper extremity during repetitive, task-oriented motor training of the paretic extremity. Extensive evidence has validated the effectiveness of CIT for enhancing post-stroke upper extremity motor recovery. No studies have evaluated how PNS may modulate the effects of CIT. Therefore, we conducted a pilot study of PNS paired with CIT and hypothesized that in subjects with stroke, pairing CIT with active PNS would lead to significantly more improved motor function in the paretic upper extremity than CIT paired with sham PNS. Outcome measures included the Fugl-Meyer Assessment Scale (FMA; primary outcome measure), the Wolf Motor Function Test (WMFT), and the Action Research Arm Test (ARAT). Nineteen chronic stroke subjects with mild to moderate upper extremity motor deficit received 2 hours of either active (n=10) or sham (n=9) PNS preceding 4 hours of CIT for 10 consecutive weekdays. Changes in FMA, WMFT, and ARAT were analyzed using factorial ANOVA. Results showed significant (p<0.05) change in all measures at completion evaluation compared with baseline (FMA (p=0.005); WMFT (p=0.030); ARAT (p=0.020)) as well as 1-month follow-up compared with baseline (FMA (p=0.048); WMFT (p=0.045); ARAT (p=0.047)). These results highlight the enormous potential for PNS paired with CIT to enhance post-stroke upper extremity motor recovery more effectively than CIT alone.

CONSTRAINT INDUCED MOVEMENT THERAPY FOR MOTOR RECOVERY IN CHRONIC STROKE PATIENT IN RURAL INDIA

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Anchit Gugnani
Keyword(s):  
Positive Reinforcement ◽  
Spontaneous Recovery ◽  
Recovery Of Function ◽  
Motor Recovery ◽  
Rural India ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Constraint Induced Movement Therapy ◽  
Recovery Stroke ◽  
Do So

A possible explanation for the substantial remaining motor deficits in stroke patients might be the occurrence of learned nonuse, a phenomenon first described by Taub. Stroke patients who initially attempt to use the affected extremity find themselves unable to do so because the process of spontaneous recovery of function has not yet proceeded sufficiently far. This results in the experience of failure or punishment for attempts to move the extremity and in positive reinforcement for compensatory movements by the unaffected extremity-a learning process that might be supported by the teaching of compensatory activity during rehabilitation. Keywords: CIMT, Motor recovery, Stroke patients

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