10 years! What did your competent? doctor do to ensure your ipsilesional primary motor and medial-premotor cortices are functioning correctly? Oh, your doctor DID NOTHING? Well congratulations, you just found out you don't have a functioning stroke doctor! My doctor never bothered to tell me most of my premotor cortex was dead, he knew nothing and did nothing.
Upper Limb Recovery After Stroke Is Associated With Ipsilesional Primary Motor Cortical Activity: A Meta-Analysis
2014, Stroke
sabelle Favre, MD; Thomas A. Zeffiro, MD, PhD; Olivier Detante, MD, PhD;
Alexandre Krainik, MD, PhD; Marc Hommel, MD; Assia Jaillard, MD, PhD
Background and Purpos
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. (Stroke. 2014;45:1077-1083.)
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