Profiling the cortex is useless, NOTHING HERE gets survivors recovered! You're fired! The idea is to solve stroke recovery, not just describe some aspect of it.
Metabolic profile of motor cortex in stroke
Motor and Premotor Cortices in Subcortical Stroke : Proton Magnetic Resonance Spectroscopy
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American Society of Neurorehabilitation
can be found at:
Neurorehabilitation and Neural Repair
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What is This? - Jan 8, 2013OnlineFirst Version of Record - Jan 9, 2013OnlineFirst Version of Record >>
at UNIV OF KANSAS MEDICAL CENTER on January 16, 2013nnr.sagepub.comDownloaded from
Neurorehabilitation and Neural RepairXX(X) 1 –10© The Author(s) 2013Reprints and permission: http://www. sagepub.com/journalsPermissions.navDOI: 10.1177/1545968312469835http://nnr.sagepub.com
Introduction
Human imaging studies have revealed that early after subcortical stroke, restoration of paretic arm function is associated with a greater involvement of radiologically normal-appearing (or spared) motor (primary motor cortex or M1) and premotor (dorsal premotor cortex or PMd, supplementary motor area or SMA) areas in both injured (ipsilesional) and uninjured (contralesional) hemispheres.
1-3
Later, successful recovery occurs in stroke survivors who exhibit relatively normal patterns of ipsilesional activation and less contralesional motor activation, whereas patients, who often show bilateral cortical activation, typically have less complete recovery.
4-6
These results should be viewed in the context of the anatomic structures and pathways of these areas. Although M1 motor pathways are critical, the premotor areas also contribute to motor control and might be recruited during motor recovery after stroke. The parallel nature of the direct (corticospinal) pathways from premotor areas and M1 emphasizes that PMd and SMA are, in some respects, at a similar level of hierarchical
XXX10.1177/1545968312469835Neuroreailitation an Neural Repair XX(X)Craciunaset al2013© TheAuthor(s) 2010Reprintsand permission: http://www.sagepub.com/journalsPermissions.nav
1 University of Kansas Medical Center, Kansas City, KS, USA
Corresponding Author:
Carmen M. Cirstea, MD, PhD Hoglund Brain Imaging Center, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1052, Kansas City, KS 66160, USA Email: ccirstea@kumc.edu
Motor and Premotor Cortices in Subcortical Stroke: Proton Magnetic Resonance Spectroscopy Measures and Arm Motor Impairment
Sorin C. Craciunas, MD, PhD 1, William M. Brooks, PhD 1, Randolph J. Nudo, PhD 1, Elena A. Popescu, PhD 1, In-Young Choi, PhD 1, Phil Lee, PhD 1, Hung-Wen Yeh, PhD 1, Cary R. Savage, PhD 1, and Carmen M. Cirstea, MD, PhD 1
. Although functional imaging and neurophysiological approaches reveal alterations in motor and premotor areas after stroke, insights into neurobiological events underlying these alterations are limited in human studies.
Objective
. We tested whether cerebral metabolites related to neuronal and glial compartments are altered in the hand representation in bilateral motor and premotor areas and correlated with distal and proximal arm motor impairment in hemiparetic persons.
Methods
. In 20 participants at >6 months postonset of a subcortical ischemic stroke and 16 age- and sex-matched healthy controls, the concentrations of N-acetylaspartate and myo-inositol were quantified by proton magnetic resonance spectroscopy. Regions of interest identified by functional magnetic resonance imaging included primary (M1), dorsal premotor (PMd), and supplementary (SMA) motor areas. Relationships between metabolite concentrations and distal (hand) and proximal (shoulder/elbow) motor impairment using Fugl-Meyer Upper Extremity (FMUE) subscores were explored.
Published by:
http://www.sagepublications.com
On behalf of:
American Society of Neurorehabilitation
can be found at:
Neurorehabilitation and Neural Repair
Additional services and information for
http://nnr.sagepub.com/cgi/alerts
Email Alerts:
http://nnr.sagepub.com/subscriptions
Subscriptions:
http://www.sagepub.com/journalsReprints.nav
Reprints:
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Permissions:
What is This? - Jan 8, 2013OnlineFirst Version of Record - Jan 9, 2013OnlineFirst Version of Record >>
at UNIV OF KANSAS MEDICAL CENTER on January 16, 2013nnr.sagepub.comDownloaded from
Neurorehabilitation and Neural RepairXX(X) 1 –10© The Author(s) 2013Reprints and permission: http://www. sagepub.com/journalsPermissions.navDOI: 10.1177/1545968312469835http://nnr.sagepub.com
Introduction
Human imaging studies have revealed that early after subcortical stroke, restoration of paretic arm function is associated with a greater involvement of radiologically normal-appearing (or spared) motor (primary motor cortex or M1) and premotor (dorsal premotor cortex or PMd, supplementary motor area or SMA) areas in both injured (ipsilesional) and uninjured (contralesional) hemispheres.
1-3
Later, successful recovery occurs in stroke survivors who exhibit relatively normal patterns of ipsilesional activation and less contralesional motor activation, whereas patients, who often show bilateral cortical activation, typically have less complete recovery.
4-6
These results should be viewed in the context of the anatomic structures and pathways of these areas. Although M1 motor pathways are critical, the premotor areas also contribute to motor control and might be recruited during motor recovery after stroke. The parallel nature of the direct (corticospinal) pathways from premotor areas and M1 emphasizes that PMd and SMA are, in some respects, at a similar level of hierarchical
XXX10.1177/1545968312469835Neuroreailitation an Neural Repair XX(X)Craciunaset al2013© TheAuthor(s) 2010Reprintsand permission: http://www.sagepub.com/journalsPermissions.nav
1 University of Kansas Medical Center, Kansas City, KS, USA
Corresponding Author:
Carmen M. Cirstea, MD, PhD Hoglund Brain Imaging Center, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1052, Kansas City, KS 66160, USA Email: ccirstea@kumc.edu
Motor and Premotor Cortices in Subcortical Stroke: Proton Magnetic Resonance Spectroscopy Measures and Arm Motor Impairment
Sorin C. Craciunas, MD, PhD 1, William M. Brooks, PhD 1, Randolph J. Nudo, PhD 1, Elena A. Popescu, PhD 1, In-Young Choi, PhD 1, Phil Lee, PhD 1, Hung-Wen Yeh, PhD 1, Cary R. Savage, PhD 1, and Carmen M. Cirstea, MD, PhD 1
Abstract
Background. Although functional imaging and neurophysiological approaches reveal alterations in motor and premotor areas after stroke, insights into neurobiological events underlying these alterations are limited in human studies.
Objective
. We tested whether cerebral metabolites related to neuronal and glial compartments are altered in the hand representation in bilateral motor and premotor areas and correlated with distal and proximal arm motor impairment in hemiparetic persons.
Methods
. In 20 participants at >6 months postonset of a subcortical ischemic stroke and 16 age- and sex-matched healthy controls, the concentrations of N-acetylaspartate and myo-inositol were quantified by proton magnetic resonance spectroscopy. Regions of interest identified by functional magnetic resonance imaging included primary (M1), dorsal premotor (PMd), and supplementary (SMA) motor areas. Relationships between metabolite concentrations and distal (hand) and proximal (shoulder/elbow) motor impairment using Fugl-Meyer Upper Extremity (FMUE) subscores were explored.
Results.
N-Acetylaspartate was lower in M1 (P = .04) and SMA (P = .004) and myo-inositol was higher in M1 (P = .003) and PMd (P = .03) in the injured (ipsilesional) hemisphere after stroke compared with the left hemisphere in controls.
N-Acetylaspartate in ipsilesional M1 was positively correlated with hand FMUE subscores (P = .04). Significant positive correlations were also found between N-acetylaspartate in ipsilesional M1, PMd, and SMA and in contralesional M1 and shoulder/elbow FMUE subscores (P = .02, .01,.02, and.02,respectively).
Conclusions
. Our preliminary results demonstrated that proton magnetic resonance spectroscopy is a sensitive method to quantify relevant neuronal changes in spared motor cortex after stroke and consequently increase our knowledge of the factors leading from these changes to arm motor impairment.
Keywords
subcortical stroke, motor and premotor cortices, proton magnetic resonance spectroscopy, distal and proximal arm motor impairment
at UNIV OF KANSAS MEDICAL CENTER on January 16, 2013nnr.sagepub.comDownloaded from
N-Acetylaspartate in ipsilesional M1 was positively correlated with hand FMUE subscores (P = .04). Significant positive correlations were also found between N-acetylaspartate in ipsilesional M1, PMd, and SMA and in contralesional M1 and shoulder/elbow FMUE subscores (P = .02, .01,.02, and.02,respectively).
Conclusions
. Our preliminary results demonstrated that proton magnetic resonance spectroscopy is a sensitive method to quantify relevant neuronal changes in spared motor cortex after stroke and consequently increase our knowledge of the factors leading from these changes to arm motor impairment.
Keywords
subcortical stroke, motor and premotor cortices, proton magnetic resonance spectroscopy, distal and proximal arm motor impairment
at UNIV OF KANSAS MEDICAL CENTER on January 16, 2013nnr.sagepub.comDownloaded from
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