Egger Philip, Evangelista Giorgia G, Koch Philipp J, Park Chang-Hyun, Levin-Gleba Laura, Girard Gabriel, Beanato Elena, Lee Jungsoo, Choirat Christine, Guggisberg Adrian G, Kim Yun-Hee, Hummel Friedhelm C
Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).
Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).
Stroke. 2021 Jun;52(6):2115-2124. doi: 10.1161/STROKEAHA.120.031541. Epub 2021 Apr 27.
Structural brain networks possess a few hubs, which are not only highly connected to the rest of the brain but are also highly connected to each other. These hubs, which form a rich-club, play a central role in global brain organization. To investigate whether the concept of rich-club sheds new light on poststroke recovery, we applied a novel network-theoretical quantification of lesions to patients with stroke and compared the outcomes with what lesion size alone would indicate.
Whole-brain structural networks of 73 patients with ischemic stroke were reconstructed using diffusion-weighted imaging data. Disconnectomes, a new type of network analyses, were constructed using only those fibers that pass through the lesion. Fugl-Meyer upper extremity scores and their changes were used to determine whether the patients show natural recovery or not.
Cluster analysis revealed 3 patient clusters: small-lesion-good-recovery, midsized-lesion-poor-recovery (MLPR), and large-lesion-poor-recovery (LLPR). The small-lesion-good-recovery consisted of subjects whose lesions were small, and whose prospects for recovery were relatively good. To explain the nondifference in recovery between the MLPR and LLPR clusters despite the difference (LLPR>MLPR) in lesion volume, we defined the [Formula: see text] metric to be the sum of the entries in the disconnectome and, more importantly, the [Formula: see text] to be the sum of all entries in the disconnectome corresponding to edges with at least one node in the rich-club. Unlike lesion volume and corticospinal tract damage (MLPR<LLPR), for [Formula: see text], this relationship was reversed (MLPR>LLPR) or showed no difference for [Formula: see text].
Smaller lesions that focus on the rich-club can be just as devastating as much larger lesions that do not focus on the rich-club, pointing to the role of the rich-club as a backbone for functional communication within brain networks and for recovery from stroke.
脑结构网络拥有一些枢纽，这些枢纽不仅与大脑其他部分高度相连，彼此之间也高度相连。这些形成富俱乐部的枢纽在全脑组织中发挥着核心作用。为了研究富俱乐部概念是否能为中风后恢复提供新的见解，我们对中风患者应用了一种新的基于网络理论的损伤量化方法，并将结果与仅根据损伤大小所预期的结果进行比较。
利用扩散加权成像数据重建了73例缺血性中风患者的全脑结构网络。仅使用穿过损伤部位的纤维构建了一种新型网络分析——分离脑图谱。采用Fugl - Meyer上肢评分及其变化来确定患者是否显示自然恢复情况。
聚类分析揭示了3个患者聚类：小损伤 - 良好恢复组、中等大小损伤 - 恢复较差组（MLPR）和大损伤 - 恢复较差组（LLPR）。小损伤 - 良好恢复组由损伤较小且恢复前景相对较好的受试者组成。为了解释尽管损伤体积存在差异（LLPR>MLPR），但MLPR和LLPR聚类在恢复方面无差异这一现象，我们将[公式：见原文]指标定义为分离脑图谱中各项的总和，更重要的是，将[公式：见原文]定义为分离脑图谱中对应于至少有一个节点位于富俱乐部中的边的所有项的总和。与损伤体积和皮质脊髓束损伤情况（MLPR<LLPR）不同，对于[公式：见原文]，这种关系是相反的（MLPR>LLPR）或对于[公式：见原文]无差异。
聚焦于富俱乐部区域的较小损伤可能与未聚焦于富俱乐部区域的大得多的损伤一样具有破坏性，这表明富俱乐部作为脑网络内功能通信和中风恢复的骨干所起的作用。
