Citations
To investigate the clinical significance of quantitative parameters in transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP) which can be adopted to predict functional recovery of the upper limb in stroke patients in the early subacute phase.
One hundred thirteen patients (61 men, 52 women; mean age 57.8±12.2 years) who suffered faiarst-ever stroke were included in this study. All participants underwent TMS-induced MEP session to assess the corticospinal excitability of both hand motor cortices within 3 weeks after stroke onset. After the resting motor threshold (rMT) was assessed, five sweeps of MEP were performed, and the mean amplitude of the MEP was measured. Latency of MEP, volume of the MEP output curve, recruitment ratios, and intracortical inhibition and facilitation were also measured. Motor function was assessed using the Fugl-Meyer Assessment scale (FMA) within 3 weeks and at 3 months after stroke onset. Correlation analysis was performed between TMS-induced MEP derived measures and FMA scores.
In the MEP response group, rMT and rMT ratio measures within 3 weeks after stroke onset showed a significant negative correlation with the total and upper limb FMA scores at 3 months after stroke (p<0.001). Multiple regression analysis revealed that FMA score and rMT ratio, but not rMT within 3 weeks were independent prognostic factors for FMA scores at 3 months after stroke.
These results indicated that the quantitative parameter of TMS-induced MEP, especially rMT ratio in the early subacute phase, could be used as a parameter to predict motor function in patients with stroke.
Citations
To investigate whether early stage diffusion tensor tractography (DTT) values predict motor function at 3 months after onset in supratentorial stroke patients with severe motor involvement.
A retrospective study design was used to analyze medical records and neuroimaging data of 49 supratentorial stroke patients with severe motor involvement. Diffusion tensor imaging was assessed within 3 weeks after stroke in all patients. Three-dimensional tractography of the ipsilateral corticospinal tract (CST) was performed using the fiber assignment of the continuous tracking algorithm. The two-step DTT analysis was used. The first step was classification according to ipsilateral CST visualization. The second step was a quantitative analysis of the visible-CST group parameters. Motor function was assessed at 2 weeks and at 3 months after stroke. Comparative and correlation analyses were performed between DTT-derived measures and motor assessment scores.
Motor function of the upper extremity at 3 months after stroke was significantly higher in the visible-CST group than that in the nonvisible-CST group (p<0.05). Early stage fractional anisotropy was of DTT correlated significantly with upper extremity motor function at 3 months after stroke in the visible-CST group (p<0.05).
These results demonstrate that early DTT-derived measures predict motor recovery in the upper extremity at 3 months after onset in supratentorial stroke patients with severe motor involvement.
Citations
To compare the low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) with high frequency (20 Hz) rTMS on motor functional improvement of the affected upper extremity in subacute stroke patients.
Forty patients with subacute ischemic stroke participated in this study. The first group received 10 sessions of 20 Hz rTMS at ipsilesional M1 area and the other group received 10 sessions of 1 Hz rTMS at contralesional M1 area. Motor training of the hemiparetic hand was conducted after each rTMS train. All the patients received conventional occupational therapy immediately after each rTMS session. Manual function test (MFT), Fugl-Meyer Assessment scale (FMS), Modified Barthel Index (MBI), Brunnstrom recovery stage, and grip strength were used to assess motor function before, at the end of, and one month after the last session of rTMS.
No adverse side effects were reported during the course of the experiment using rTMS. No significant difference in motor function of the affected upper extremity was observed between the two groups before rTMS. Significant improvements in MFT, FMS, MBI, and Brunnstrom stage were observed in the both groups at the end of the last rTMS session and one month later (p<0.05). No significant difference was found between the two groups (p>0.05).
There was no significant difference in motor function of the affected upper extremity between 1 Hz and 20 Hz rTMS during the subacute period of ischemic stroke. Thus, we cannot conclude which has a greater effect.
Citations
To evaluate the effects of electric cortical stimulation in the experimentally induced focal traumatic brain injury (TBI) rat model on motor recovery and plasticity of the injured brain.
Twenty male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT) and on a Rotarod task (RRT) for 14 days. Then, the TBI model was induced by a weight drop device (40 g in weight, 25 cm in height) on the dominant motor cortex, and the electrode was implanted over the perilesional cortical surface. All rats were divided into two groups as follows: Electrical stimulation (ES) group with anodal continuous stimulation (50 Hz and 194 µs duration) or Sham-operated control (SOC) group with no electrical stimulation. The rats were trained SPRT and RRT for 14 days for rehabilitation and measured Garcia's neurologic examination. Histopathological and immunostaining evaluations were performed after the experiment.
There were no differences in the slice number in the histological analysis. Garcia's neurologic scores & SPRT were significantly increased in the ES group (p<0.05), yet, there was no difference in RRT in both groups. The ES group showed more expression of c-Fos around the brain injured area than the SOC group.
Electric cortical stimulation with rehabilitation is considered to be one of the trial methods for motor recovery in TBI. However, more studies should be conducted for the TBI model in order to establish better stimulation methods.
Citations
To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke.
Ten patients with first-ever subcortical stroke (55.7±17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7±25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau.
The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facilitation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery.
Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery significantly.
Citations
To compare the motor recovery following transverse myelitis in pediatric patients with and without spinal cord atrophy.
From January 1995 through December 2009, twenty children (8 boys and 12 girls with an onset at 5.7±3.8 years) that were diagnosed with transverse myelitis at a Children's Hospital in Korea, and undertaken an initial and follow-up spine magnetic resonance image (MRI) were included. Medical records and spine MRI scans were reviewed retrospectively. An initial MRI was taken 5.1±8.7 days after the onset. The interval between an initial and follow-up MRIs was 33.4±23.0 days. The motor recovery differences between subjects with and without spinal cord atrophy on follow-up MRIs were determined. Motor recovery was defined as the elevation of one or more grades of manual muscle tests of the Medical Research Council.
Eight patients had developed spinal cord atrophies and 12 patients had not. Of the 8 patients with spinal cord atrophy, 7 showed no motor improvement. Among the 12 patients without atrophy, 11 had motor improvement. Spinal cord atrophy on follow-up MRIs were related to the risk of no motor improvement (odds ratio=77.0, 95% confidence interval [4.114-1441.049], p-value=0.001).
Children with transverse myelitis who had developed spinal cord atrophy on follow-up MRIs had poor motor recovery than those who had not. The appearance of spinal cord atrophy on follow-up MRI could be an indicator of poor prognosis in pediatric transverse myelitis.
Citations
Objective: This study was designed to see the effect of swimming exercise in the rats after experimental contusive spinal cord injury.
Method: Twenty six Sprague-Dawley rats (weight, 300 to 350 g) were divided into control (n=9) and experimental swimming groups (n=17). With the Spinal Cord Dropping Device (NYU, U.S.A.), contusive injury to the spinal cord was induced at the eighth thoracic level in both groups. Rats of the experimental group put to swim for 5 minutes a day during the second week and then swimming times a day were increased in one number to each week. But the other ten rats were remained without swimming exercise as the control. Functional recovery of the hind limb was evaluated by the inclined board plane test, the Bassoe Beattie Bresnahan (BBB) locomotor rating scales and histological findings of injured spinal cord.
Results: 1) Upward maximal angles of the inclined plane test were significantly greater in experimental group than control group after 10 days post-injury (p＜0.05). 2) BBB scores were higher in experimental group than control group at 14 days after injury (p＜0.05).
Conclusion: This study suggests that swimming applied from the early phase after spinal cord injury be beneficial in the early recovery of motor function.
Objective: The purpose of this study was to evaluate the motor recovery of initial and plateau period in the patients with subcortical stroke lesion which were different locations.
Method: We studied the 42 stroke patients with subcortical lesions who had been admitted to the Department of Rehabilitation Medicine from 1998 to 2000, retrospectively. Patients were divided into four groups according to the information from brain CT or MRI; Group 1: basal ganglia, group 2: anterior limb of internal capsule and/or basal ganglia, group 3: posterior limb of internal capsule and/or basal ganglia and group 4: thalamus only. Quantitative assessments of motor recovery using the Brunnstrom stage and results were correlated with sites of lesion.
Results: 1) Brunnstrom stages at initial and plateau period were the highest in the patients with thalamic lesion and the lowest in the patients with posterior limb of internal capsule and/or basal ganglia lesion. The patients with thalamic lesion showed higher stage than the patients with basal ganglia with anterior limb lesion in hand and low extremity (p＜0.05). 2) Significant motor recovery was occurred in all patients except the lesion located in thalamus (p＜0.05).
Conclusion: There were significant differences of motor recovery at plateau period in the patients with thalamic lesions comparing with basal ganglia with anterior limb lesion about hands and lower extremities and patients with basal ganglia and/or capsular lesion showed good motor recovery.
Objective: To find out the motor recovery in stroke patients according to the presence of diaschisis.
Method: Computed tomography (CT) and/or magnetic resonance imaging (MRI) scan and single photon emission computed tomography (SPECT) study were performed on a consecutive series of 98 inpatients from July 1995 to August 1996. Among them 42 stroke patients were included in this study with cerebellar, pontine, and bilateral hemispheric lesions excluded.
Results: The types of diaschisis were crossed cerebellar diaschisis (CCD) (36 cases), thalamocortical diaschisis (6 cases), striatocortical diaschisis (5 cases), and capsulocortical diaschisis (1 case). And the functional recovery scale improved from 37.5 points to 53.0 points by the motricity index and from 41.2 points to 68.8 points by the MBI score. Only the motricity index showed a significant inverse correlation with the asymmetry index in CCD.
Conclusion: Although other types of diaschisis were found, the most frequent type was CCD. The lower the asymmetry score was the lower motricity index. Therefore, CCD could be a prognostic factor for the motor recovery.
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