Longitudinal Assessment of Motor Recovery of Contralateral Hand after Basal Ganglia Infarction Using Functional Magnetic Resonance Imaging

We used functional fMRI to study the brain activation during active finger movements at different time points during the recovery phase following basal ganglia infarction. Four hemiplegic patients with basal ganglia infarction were serially evaluated at different time points spanning the acute and chronic phase using fMRI. To evaluate motor recovery, the patients were asked to perform functional tasks arranged in a block design manner with their hand. On follow-up (chronic phase), three patients achieved significant recovery of motor function of affected limbs. Activation of bilateral sensorimotor cortex (SMC) was observed in two of these patients, while activation of cerebellum was observed in all patients. No remarkable recovery of motor function was noted in one patient with left basal ganglia infarction. In this patient, the activation domain was located in SMC of both sides in acute phase and in ipsilateral SMC in chronic phase. Contralateral SMC appears to be involved in the functional rehabilitation following basal ganglia infarction. The cerebellum may act as an intermediary during functional recovery following basal ganglia infarction. The activation domain associated with active finger movement may be bilateral in acute phase; one patient was ipsilateral in the chronic stage.

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Abstract 101: Predicting Motor Recovery at One Week After Ischemic Stroke: a Combined Transcranial Magnetic Stimulation and MRI Study

Stroke ◽

10.1161/str.48.suppl_1.101 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yukako Takahashi ◽

Naoya Oishi ◽

Tatsuya Mima ◽

Hidenao Fukuyama ◽

Ryosuke Takahashi ◽

...

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Transcranial Magnetic Stimulation ◽

Acute Phase ◽

Magnetic Stimulation ◽

Chronic Phase ◽

Asymmetry Index ◽

Motor Recovery ◽

Cerebral Peduncle ◽

Patient Stratification

Introduction: The failure of numerous stroke clinical trials partially lies in the difficulty in predicting motor recovery in the acute phase. Because of the interindividual variability in subsequent recovery, better prediction of motor prognosis and earlier patient stratification are required to design a promising protocol for clinical trials. Recently, an algorithm to predict motor recovery at 2 weeks after stroke has been reported by combining diffusion-weighted MRI and transcranial magnetic stimulation (TMS); however, 2 weeks may be too late for therapeutic intervention. The aim of this study was therefore to explore how to predict motor recovery even earlier at 1 week after ischemic stroke. Subjects and Methods: Twenty-five patients with acute ischemic stroke (67.9±10.5 years old) who showed supratentorial lesions and hemiparesis of the upper extremity were prospectively enrolled. Integrity of the corticospinal tract was assessed structurally with MRI and functionally with TMS within 7 days after onset (acute phase), at 10-20 days (subacute), and at 6 months (chronic). The fractional anisotropy (FA) asymmetry index (FAcontra-FAipsi)/(FAcontra+FAipsi) at the level of the cerebral peduncle was calculated on MRI, while motor evoked potential (MEP) was recorded on TMS. The Fugl-Meyer scale was used to evaluate upper limb impairment in the subacute and chronic phase. Results: Patients with detectable MEP at 1 week after onset showed significantly higher Fugl-Meyer score at 6 months compared to those without MEP (65.4 versus 33.6, p=0.011). Those with FA asymmetry index of less than 0.024 at 1 week showed significantly higher Fugl-Meyer score at 6 months compared to those with the index above 0.024 (64.2 versus 40.1, p=0.037). Conclusion: Presence of MEP and smaller asymmetry of FA at 1 week after ischemic stroke could be a useful biomarker for predicting better motor recovery. This finding can be useful in earlier patient stratification in future clinical trials.

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Relationship between recovery of motor function and neuropsychological functioning in cerebral infarction patients: the importance of social functioning in motor recovery

Journal of Integrative Neuroscience ◽

10.31083/j.jin.2020.03.175 ◽

2020 ◽

Vol 19 (3) ◽

pp. 405

Author(s):

Min Cheol Chang ◽

Sung-Won Park ◽

Byung-Joo Lee ◽

Donghwi Park

Keyword(s):

Cerebral Infarction ◽

Social Functioning ◽

Motor Function ◽

Neuropsychological Functioning ◽

Motor Recovery ◽

Recovery Of Motor Function

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Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/1545968319862557 ◽

2019 ◽

Vol 33 (8) ◽

pp. 681-690 ◽

Cited By ~ 9

Author(s):

Susan M. Linder ◽

Anson B. Rosenfeldt ◽

Sara Davidson ◽

Nicole Zimmerman ◽

Amanda Penko ◽

...

Keyword(s):

Aerobic Exercise ◽

Motor Function ◽

Skill Acquisition ◽

Randomized Clinical Trials ◽

Motor Recovery ◽

Voluntary Exercise ◽

Fine Motor ◽

Significant Interaction Effect ◽

Task Practice ◽

Recovery Of Motor Function

Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke. Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke. Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks. Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group ( P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times ( P ≤ .01 for all observations). Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.

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Effects of Diabetes on Motor Recovery After Cerebral Infarct: A Diffusion Tensor Imaging Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-02502 ◽

2019 ◽

Vol 104 (9) ◽

pp. 3851-3858 ◽

Cited By ~ 4

Author(s):

Jun Sung Moon ◽

Seung Min Chung ◽

Sung Ho Jang ◽

Kyu Chang Won ◽

Min Cheol Chang

Keyword(s):

Motor Function ◽

Corticospinal Tract ◽

Diffusion Tensor ◽

Imaging Study ◽

Motor Recovery ◽

Cerebral Infarct ◽

Corona Radiata ◽

Patients With Diabetes ◽

Diffusion Tensor Imaging Study ◽

Recovery Of Motor Function

AbstractObjectiveLittle is known about the effects of diabetes on motor recovery after cerebral infarct. To address this question, we recruited patients with corona radiata infarct and controlled for the integrity of the corticospinal tract (CST) as determined by diffusion tensor tractography (DTT).DesignOne hundred patients were recruited, and DTT was performed within 7 to 30 days of infarct onset. Based on the DTT findings (DTT+, CST was preserved around the infarct; DTT−, CST was interrupted by the infarct) and the presence (DM+) or absence (DM−) of diabetes, patients were divided into DTT+/DM− (36 patients), DTT+/DM+ (19 patients), DTT−/DM− (32 patients), and DTT−/DM+ (13 patients) groups. Six months after cerebral infarct, motor function on the affected side was evaluated for each patient via the upper motricity index (MI), lower MI, modified Brunnstrom classification (MBC), and functional ambulation category (FAC).ResultsIn the patients with a DTT+ finding, no motor function scores were significantly different between the DTT+/DM− and DTT+/DM+ groups at 6-month evaluation. However, in patients with DTT− finding, all motor function scores at the 6-month evaluation were significantly higher in the DTT−/DM− group than in the DTT−/DM+ group.ConclusionWhen the CST is interrupted by a corona radiata infarct, recovery of motor function in patients with diabetes is more impaired than those without diabetes.

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Recovery of motor function of chronic spinal cord injury by extracellular pyruvate kinase isoform M2 and the underlying mechanism

Scientific Reports ◽

10.1038/s41598-020-76629-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Takahiro Kikuchi ◽

Chihiro Tohda ◽

Masato Suyama

Keyword(s):

Spinal Cord ◽

Pyruvate Kinase ◽

Motor Function ◽

Motor Neurons ◽

Chronic Phase ◽

Indirect Evidence ◽

Cord Injury ◽

Axonal Density ◽

Recovery Of Motor Function

Abstract In our previous study, we found that pyruvate kinase isoform M2 (PKM2) was secreted from the skeletal muscle and extended axons in the cultured neuron. Indirect evidence suggested that secreted PKM2 might relate to the recovery of motor function in spinal cord injured (SCI) mice. However, in vivo direct evidence has not been obtained, showing that extracellular PKM2 improved axonal density and motor function in SCI mice. In addition, the signal pathway of extracellular PKM2 underlying the increase in axons remained unknown. Therefore, this study aimed to identify a target molecule of extracellular PKM2 in neurons and investigate the critical involvement of extracellular PKM2 in functional recovery in the chronic phase of SCI. Recombinant PKM2 infusion to the lateral ventricle recovered motor function in the chronic phase of SCI mice. The improvement of motor function was associated with axonal increase, at least of raphespinal tracts connecting to the motor neurons directly or indirectly. Target molecules of extracellular PKM2 in neurons were identified as valosin-containing protein (VCP) by the drug affinity responsive target stability method. ATPase activation of VCP mediated the PKM2-induced axonal increase and recovery of motor function in chronic SCI related to the increase in axonal density. It is a novel finding that axonal increase and motor recovery are mediated by extracellular PKM2-VCP-driven ATPase activity.

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1. Functional role of basal ganglia : Recovery of motor function and its problems in neural transplantation (B5 Involuntary movement : Basic and clinical approaches)

Japanese Journal of Neurosurgery ◽

10.7887/jcns.13.301_1 ◽

2004 ◽

Vol 13 (4) ◽

pp. 301

Author(s):

Hideki Hida

Keyword(s):

Basal Ganglia ◽

Motor Function ◽

Functional Role ◽

Involuntary Movement ◽

Neural Transplantation ◽

Recovery Of Motor Function

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Parasite load during the acute phase of murine T. cruzi infection determines the activation pattern of the immune system in late chronic phase

Immunology Letters ◽

10.1016/s0165-2478(97)88570-7 ◽

1997 ◽

Vol 56 (1-3) ◽

pp. 426-427

Author(s):

C Marinho

Keyword(s):

Immune System ◽

Acute Phase ◽

Chronic Phase ◽

Parasite Load ◽

Activation Pattern ◽

Cruzi Infection

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Motor Recovery after Chronic Spinal Cord Transection in Rats: A Proof-of-Concept Study Evaluating a Combined Strategy

CNS & Neurological Disorders - Drug Targets ◽

10.2174/1871527317666181105101756 ◽

2019 ◽

Vol 18 (1) ◽

pp. 52-62 ◽

Cited By ~ 1

Author(s):

Antonio Ibarra ◽

Erika Mendieta-Arbesú ◽

Paola Suarez-Meade ◽

Elisa García-Vences ◽

Susana Martiñón ◽

...

Keyword(s):

Spinal Cord ◽

Treatment Strategies ◽

Chronic Phase ◽

Motor Recovery ◽

Neural Regeneration ◽

Histological Evaluation ◽

Control Group ◽

Proof Of Concept ◽

Sprague Dawley ◽

Concept Study

Background: The chronic phase of Spinal Cord (SC) injury is characterized by the presence of a hostile microenvironment that causes low activity and a progressive decline in neurological function; this phase is non-compatible with regeneration. Several treatment strategies have been investigated in chronic SC injury with no satisfactory results. OBJECTIVE- In this proof-of-concept study, we designed a combination therapy (Comb Tx) consisting of surgical glial scar removal plus scar inhibition, accompanied with implantation of mesenchymal stem cells (MSC), and immunization with neural-derived peptides (INDP). Methods: This study was divided into three subsets, all in which Sprague Dawley rats were subjected to a complete SC transection. Sixty days after injury, animals were randomly allocated into two groups for therapeutic intervention: control group and animals receiving the Comb-Tx. Sixty-three days after treatment we carried out experiments analyzing motor recovery, presence of somatosensory evoked potentials, neural regeneration-related genes, and histological evaluation of serotoninergic fibers. Results: Comb-Tx induced a significant locomotor and electrophysiological recovery. An increase in the expression of regeneration-associated genes and the percentage of 5-HT+ fibers was noted at the caudal stump of the SC of animals receiving the Comb-Tx. There was a significant correlation of locomotor recovery with positive electrophysiological activity, expression of GAP43, and percentage of 5-HT+ fibers. Conclusion: Comb-Tx promotes motor and electrophysiological recovery in the chronic phase of SC injury subsequent to a complete transection. Likewise, it is capable of inducing the permissive microenvironment to promote axonal regeneration.

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