http://stroke.ahajournals.org/content/45/4/1077.abstract?etoc
- Isabelle Favre, MD;
- Thomas A. Zeffiro, MD, PhD;
- Olivier Detante, MD, PhD;
- Alexandre Krainik, MD, PhD;
- Marc Hommel, MD;
- Assia Jaillard, MD, PhD
+ Author Affiliations
- Correspondence to Assia Jaillard, MD, PhD, Unité IRM 3T—Recherche CHU Grenoble CS 10217, 38043 Grenoble Cedex 9, France. E-mail Assia.Jaillard@ujf-grenoble.fr
Abstract
Background and Purpose—Although
neuroimaging studies have revealed specific patterns of reorganization
in the sensorimotor control network after
stroke, their role in recovery remains
unsettled. To review the existing evidence systematically, we performed
activation
likelihood estimation meta-analysis of
functional neuroimaging studies investigating upper limb
movement-related brain activity
after stroke.
Methods—Twenty-four
studies using sensorimotor tasks in standardized coordinates were
included, totaling 255 patients and 145 healthy
controls. Across the entire brain, we
compared task-related activity patterns in good and poor recovery and
assessed the magnitude
of spatial shifts in sensorimotor activity in
cortical motor areas after stroke.
Results—When
compared with healthy controls, patients showed higher activation
likelihood estimation values in contralesional primary
motor soon after stroke that abated with
time, but were not related to motor outcome. The observed activity
changes were consistent
with restoration of typical interhemispheric
balance. In contrast, activation likelihood estimation values in
ipsilesional
medial-premotor and primary motor cortex were
associated with good outcome, reorganization that may reflect vicarious
processes
associated with ventral activity shifts from
BA4a to 4p. In the anterior cerebellum, a novel finding was the
association of
poor recovery with increased vermal activity,
possibly reflecting behaviorally inadequate compensatory strategies
engaging
the fastigio-thalamo-cortical and
corticoreticulospinal systems.
Conclusions—Activity
in ipsilesional primary motor and medial-premotor cortices in chronic
stroke signals good motor recovery, whereas
cerebellar vermis activity signals poor
recovery. Functional MRI may be useful in identifying recovery
biomarkers.
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