The Role of White Matter Integrity and Neuroplasticity in Stroke Recovery: Insights from DTI and VBM

 Useless. Nothing here tells exactly what to do to get recovered! I'd fire all of you!

The Role of White Matter Integrity and Neuroplasticity in Stroke Recovery: Insights from DTI and VBM

View ORCID Profilerongjun zhang, Zhigang Gong, Wenbing Jiang, Zhaofeng Su

doi: https://doi.org/10.1101/2025.01.07.25320143

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

000000

• Abstract
• Info/History
• Metrics
• Preview PDF

Abstract

Background 

 Stroke is a leading cause of disability, significantly affecting the brain’s white and gray matter. Neuroimaging techniques like Diffusion Tensor Imaging (DTI) and Voxel-Based Morphometry (VBM) offer valuable insights into these structural changes. 

 Methods 

 This study used Tract-Based Spatial Statistics (TBSS) to evaluate white matter integrity in stroke patients using DTI metrics, including Fractional Anisotropy (FA) and Mean Diffusivity (MD). VBM was employed to assess gray matter volume and cortical thickness. Correlation analyses were performed between imaging metrics and clinical scores, such as the NIH Stroke Scale (NIHSS) and Brunnstrom scores. 

 Results 

 TBSS analysis showed significant reductions in FA (globus pallidus: t = -4.71, p < 0.001; caudate nucleus: t = -4.20, p < 0.001) and increases in MD (globus pallidus: t = 3.96, p < 0.001; caudate nucleus: t = 3.85, p < 0.001) in stroke patients compared to controls. These changes correlated significantly with clinical outcomes; higher FA and lower MD were linked to better motor function (Brunnstrom score: r = 0.90, p < 0.001 for FA in globus pallidus) and lower stroke severity (NIHSS score: r = -0.91, p < 0.001 for FA in globus pallidus). VBM analysis revealed significant gray matter volume increases in the anterior cingulate cortex and six other regions at p < 0.001. 

 Conclusion 

 The study underscores the importance of white matter integrity in post-stroke recovery and highlights neuroplasticity in specific brain regions. Neuroimaging metrics like FA, MD, and gray matter volume are crucial for assessing stroke severity and guiding rehabilitation strategies.

White Matter Integrity Predicts Electrical Stimulation (tDCS) and Language Therapy Effects in Primary Progressive Aphasia

 You'll have to ask your doctor if they have both the TBS and DTI machines. YOUR RESPONSIBILTY to get those machines in if you need them. Your hospital will do nothing.

White Matter Integrity Predicts Electrical Stimulation (tDCS) and Language Therapy Effects in Primary Progressive Aphasia

Show all authors

Yi Zhao, PhD, Bronte Ficek, MHS, Kimberly Webster, MA, ...

First Published December 14, 2020 Research Article 

https://doi.org/10.1177/1545968320971741

Article information

 

Abstract

Background

Transcranial direct current stimulation (tDCS), in conjunction with language therapy, improves language therapy outcomes in primary progressive aphasia (PPA). However, no studies show whether white matter integrity predicts language therapy or tDCS effects in PPA.

Objective

We aimed to determine whether white matter integrity, measured by diffusion tensor imaging (DTI), predicts written naming/spelling language therapy effects (letter accuracy on trained and untrained words) with and without tDCS over the left inferior frontal gyrus (IFG) in PPA.

Methods

Thirty-nine participants with PPA were randomly assigned to tDCS or sham condition, coupled with language therapy for 15 daily sessions. White matter integrity was measured by mean diffusivity (MD) and fractional anisotropy (FA) in DTI scans before therapy. Written naming outcomes were evaluated before, immediately after, 2 weeks, and 2 months posttherapy. To assess tDCS treatment effect, we used a mixed-effects model with treatment evaluation and time interaction. We considered a forward model selection approach to identify brain regions/fasciculi of which white matter integrity can predict improvement in performance of word naming.

Results

Both sham and tDCS groups significantly improved in trained items immediately after and at 2 months posttherapy. Improvement in the tDCS group was greater and generalized to untrained words. White matter integrity of ventral language pathways predicted tDCS effects in trained items whereas white matter integrity of dorsal language pathways predicted tDCS effects in untrained items.

Conclusions

White matter integrity influences both language therapy and tDCS effects. Thus, it holds promise as a biomarker for deciding which patients will benefit from language therapy and tDCS.

Keywords white matter integrity, primary progressive aphasia (PPA), transcranial direct current stimulation (tDCS), language therapy, white matter, electrical stimulation, neurodegeneration, prediction

Access Options

 

White Matter Integrity Is a Stronger Predictor of Motor Function Than BOLD Response in Patients With Stroke

 So what? Deal with the real world sometime. What protocol are you providing to ensure white matter integrity? You've had 9 years to come up with something. WHERE IS IT?

White Matter Integrity Is a Stronger Predictor of Motor Function Than BOLD Response in Patients With Stroke

 2011, Neurorehabilitation and Neural Repair
 Mingguo Qiu, MD 1, 

Warren G. Darling, PhD 2, 

Robert J. Morecraft, PhD 3, 

Chun Chun Ni 4, 

Justin Rajendra 4, 5, 

and Andrew J. Butler, PhD 4, 5

Abstract

Objective.
 
Neuroimaging techniques, such as diffusion tensor imaging (DTI) and blood oxygenation level–dependent (BOLD) functional magnetic resonance imaging (fMRI), provide insights into the functional reorganization of the cortical motor system after stroke. This study explores the relationship between upper extremity motor function, white matter integrity, and BOLD response of cortical motor areas.
 Methods.
 
Seventeen patients met study inclusion criteria; of these 12 completed DTI assessment of white matter integrity and 9 completed fMRI assessment of motor-related activation. Primary clinical outcome measures were the Wolf Motor Function Test (WMFT) and the upper limb portion of the Fugl-Meyer (FM) motor assessment. Structural integrity of the posterior limb of the internal capsule was assessed by examining the fractional anisotropy (FA) asymmetry in the PLIC. Laterality index of motor cortical areas was measured as the BOLD response in each patient during a finger pinch task. Linear regression analyses were performed to determine whether clinical outcome was associated with structural or functional MRI measures.
Results.
 
There were strong relationships between clinical outcome measures and FA asymmetry (eg, FM score [R²=.655,P=.001] and WMFT asymmetry score [R²=.651,P <.002]) but relationships with fMRI measures were weaker.
Conclusion.
 
Clinical motor function is more closely related to the white matter integrity of the internal capsule than to BOLD response of motor areas in patients 3 to 9 months after stroke. Thus, use of DTI to assess white matter integrity in the internal capsule may provide more useful information than fMRI to interpret motor deficits following supratentorial brain injury.