Upper Limb Recovery After Stroke Is Associated With Ipsilesional Primary Motor Cortical Activity: A Meta-Analysis

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.)