Longitudinal Structural and Functional Differences Between Proportional and Poor Motor Recovery After Stroke

I hate these wastes of time, researching trying to predict recovery. You goddamn fuckers, solve the problems in stroke instead of being lazy. And these are Ph. Ds and MDs. Or do you think stroke is so well solved, nothing needs to be done?  I'm being bad again, once again not following Dale Carnegie, 'How to Win Friends and Influence People'.
http://journals.sagepub.com/doi/abs/10.1177/1545968317740634

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Adrian G. Guggisberg, MD¹²

Adrian G. Guggisberg

1Geneva University Hospital, Geneva, Switzerland2University of Geneva, Geneva, Switzerland
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, Pierre Nicolo, PhD¹²

Pierre Nicolo

1Geneva University Hospital, Geneva, Switzerland2University of Geneva, Geneva, Switzerland
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, Leonardo G. Cohen, MD³*

Leonardo G. Cohen

3National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Armin Schnider, MD¹²

Armin Schnider

1Geneva University Hospital, Geneva, Switzerland2University of Geneva, Geneva, Switzerland
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, Ethan R. Buch, PhD³

Ethan R. Buch

3National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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First Published November 12, 2017 Research Article

https://doi.org/10.1177/1545968317740634

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Article Information

Volume: 31 issue: 12, page(s): 1029-1041

Article first published online: November 12, 2017; Issue published: December 1, 2017

https://doi.org/10.1177/1545968317740634

Adrian G. Guggisberg, MD^{1, 2}, Pierre Nicolo, PhD^{1, 2}, Leonardo G. Cohen, MD³*, Armin Schnider, MD^{1, 2}, Ethan R. Buch, PhD³

¹Geneva University Hospital, Geneva, Switzerland

²University of Geneva, Geneva, Switzerland

³National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

Corresponding Author: Adrian G. Guggisberg, Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospital, Avenue de Beau-Séjour 26, 1211 Geneva 14, Switzerland. Email: aguggis@gmail.com

*This author is a member of The American Society of Neurorehabilitation.

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Abstract

Background. Evolution of motor function during the first months after stroke is stereotypically bifurcated, consisting of either recovery to about 70% of maximum possible improvement (“proportional recovery, PROP”) or in little to no improvement (“poor recovery, POOR”). There is currently no evidence that any rehabilitation treatment will prevent POOR and favor PROP. Objective. To perform a longitudinal and multimodal assessment of functional and structural changes in brain organization associated with PROP.
Methods. Fugl-Meyer Assessments of the upper extremity and high-density electroencephalography (EEG) were obtained from 63 patients, diffusion tensor imaging from 46 patients, at 2 and 4 weeks (T0) and at 3 months (T1) after stroke onset.
Results. We confirmed the presence of 2 distinct recovery patterns (PROP and POOR) in our sample. At T0, PROP patients had greater integrity of the corticospinal tract (CST) and greater EEG functional connectivity (FC) between the affected hemisphere and rest of the brain, in particular between the ventral premotor and the primary motor cortex. POOR patients suffered from degradation of corticocortical and corticofugal fiber tracts in the affected hemisphere between T0 and T1, which was not observed in PROP patients. Better initial CST integrity correlated with greater initial global FC, which was in turn associated with less white matter degradation between T0 and T1.
Conclusions. These findings suggest links between initial CST integrity, systems-level cortical network plasticity, reduction of white matter atrophy, and clinical motor recovery after stroke. This identifies candidate treatment targets.