Stratifying chronic stroke patients based on the influence of contralesional motor cortices: An inter-hemispheric inhibition study.
Corticospinal
Diffusion Tensor Imaging (DTI)
Inter-Hemispheric Inhibition (IHI)
Motor function
Rehabilitation
Stroke
Transcranial Magnetic Stimulation (TMS)
Upper limb
Journal
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
ISSN: 1872-8952
Titre abrégé: Clin Neurophysiol
Pays: Netherlands
ID NLM: 100883319
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
04
09
2019
revised:
29
05
2020
accepted:
02
06
2020
pubmed:
28
7
2020
medline:
27
5
2021
entrez:
27
7
2020
Statut:
ppublish
Résumé
A recent "bimodal-balance recovery" model suggests that contralesional influence varies based on the amount of ipsilesional reserve: inhibitory when there is a large reserve, but supportive when there is a low reserve. Here, we investigated the relationships between contralesional influence (inter-hemispheric inhibition, IHI) and ipsilesional reserve (corticospinal damage/impairment), and also defined a criterion separating subgroups based on the relationships. Twenty-four patients underwent assessment of IHI using Transcranial Magnetic Stimulation (ipsilateral silent period method), motor impairment using Upper Extremity Fugl-Meyer (UEFM), and corticospinal damage using Diffusion Tensor Imaging and active motor threshold. Assessments of UEFM and IHI were repeated after 5-week rehabilitation (n = 21). Relationship between IHI and baseline UEFM was quadratic with criterion at UEFM 43 (95%conference interval: 40-46). Patients less impaired than UEFM = 43 showed stronger IHI with more impairment, whereas patients more impaired than UEFM = 43 showed lower IHI with more impairment. Of those made clinically-meaningful functional gains in rehabilitation (n = 14), more-impaired patients showed further IHI reduction. A criterion impairment-level can be derived to stratify patient-subgroups based on the bimodal influence of contralesional cortex. Contralesional influence also evolves differently across subgroups following rehabilitation. The criterion may be used to stratify patients to design targeted, precision treatments.
Identifiants
pubmed: 32712080
pii: S1388-2457(20)30387-4
doi: 10.1016/j.clinph.2020.06.016
pmc: PMC7487004
mid: NIHMS1615976
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2516-2525Subventions
Organisme : NICHD NIH HHS
ID : K01 HD069504
Pays : United States
Organisme : NICHD NIH HHS
ID : R01 HD098073
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest Andre G. Machado has the following conflicts of interest: ATI, Enspire and Cardionomics (distribution rights from intellectual property), St Jude (consultant) and Medtronic (Fellowship support). Other authors declare that there is no conflict of interest associated with this work. Specifically, there are no financial or personal relationships with other people or organizations that could inappropriately influence or bias this work.
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