Ann Rehabil Med.  2012 Aug;36(4):501-511. 10.5535/arm.2012.36.4.501.

Prediction of Motor Function Recovery after Subcortical Stroke: Case Series of Activation PET and TMS Studies

• Jung SH
• Kim YK
• Kim SE
• Paik NJ

• KMID: 2266721
• DOI: http://doi.org/10.5535/arm.2012.36.4.501

Abstract

OBJECTIVE
To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke. METHOD: Ten patients with first-ever subcortical stroke (55.7+/-17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7+/-25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau.
RESULTS
The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facilitation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery.
CONCLUSION
Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery significantly.

Keyword

Stroke; Motor recovery; PET; Transcranial magnetic stimulation; Activation pattern

MeSH Terms

Brain
Glucose
Humans
Muscles
Positron-Emission Tomography
Recovery of Function
Stroke
Transcranial Magnetic Stimulation
Glucose

Figure

• 

  Fig. 1 A patient in a good recovery group (Patient 4). (A) Brain CT showed a hemorrhagic lesion in the right thalamus. (B) During the motor task, activation was observed in the cerebellum and perilesional motor cortex (arrow) on her FDG-PET. (C) Normal ICI and ICF response patterns were observed in bilateral motor cortices on the paired pulse TMS. ICI: Intracortical inhibition, ICF: Intracortical facilitation, ISI: Interstimulus interval, ms: Milliseconds.

• 

  Fig. 2 A patient in a fair recovery group (Patient 3). (A) Brain MRI showed an acute infarct in the left corona radiata. (B) During the motor task, activation occurred in the contralateral motor cortex, the cerebellum, the perilesional area, bilateral frontal cortices and thalamus. (C) No MEP was observed in the affected APB, but normal ICI and ICF patterns were observed in the unaffected side. ICI: Intracortical inhibition, ICF: Intracortical facilitation, ISI: Interstimulus interval, ms: Milliseconds.

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