Ofir-Geva Shay, Meilijson Isaac, Frenkel-Toledo Silvi, Soroker Nachum
Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel, Department of Rehabilitation Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
School of Mathematical Sciences, Tel-Aviv University, Israel.
Harefuah. 2024 Sep;163(9):552-557.
The identification of brain structures that are critical for upper limb residual motor function following stroke is an essential step towards the development of advanced treatment modalities for improving rehabilitation outcomes among brain-injured patients, such as non-invasive brain stimulation techniques, which aim to induce neuroplasticity in motor-critical brain regions. In the current study we attempted to identify the critical brain regions for upper limb motor function among stroke patients, using three different methods of lesion-symptom mapping (LSM).
Brain imaging data and Fugl-Meyer Assessment for upper-limb (FMA) scores for 107 patients admitted to the neurological rehabilitation department at Loewenstein Rehabilitation Medical Center, were analyzed using 3 LSM methods: Voxel-based Lesion-Symptom Mapping (VLSM), Region-based Lesion-Symptom Mapping (RLSM), and Multi-perturbation Shapley-value Analysis (MSA).
In left-hemispheric damaged (LHD) patients only a relatively small number of brain regions were found, in comparison with right-hemispheric damaged (RHD) patients. For LHD, two regions important for movement planning were found to be critical - the supplementary motor area and the premotor area. For RHD, parts of the temporal, frontal and insular cortices, as well as the cingulate gyrus were exclusively detected as critical. Sub-cortical brain structures (basal ganglia, corona radiata, internal capsule and superior longitudinal fasciculus) were detected in both hemispheres.
Despite the variability between different LSM methods, all methods have consistently shown a difference between the critical brain-regions for upper-limb function following LHD vs. RHD. These findings support previous works suggesting that the left (motor-dominant) hemisphere is more inter-connected, thus it has higher redundancy and decreased vulnerability to focal damage.
确定中风后对上肢残余运动功能至关重要的脑结构，是开发先进治疗方式以改善脑损伤患者康复结果的关键一步，比如旨在诱导运动关键脑区神经可塑性的非侵入性脑刺激技术。在本研究中，我们尝试使用三种不同的损伤-症状映射（LSM）方法，确定中风患者中对上肢运动功能至关重要的脑区。
对洛温斯坦康复医学中心神经康复科收治的107例患者的脑成像数据和上肢Fugl-Meyer评估（FMA）分数，使用三种LSM方法进行分析：基于体素的损伤-症状映射（VLSM）、基于区域的损伤-症状映射（RLSM）和多扰动沙普利值分析（MSA）。
与右半球损伤（RHD）患者相比，左半球损伤（LHD）患者仅发现相对较少的脑区。对于LHD，发现对运动规划重要的两个区域至关重要——辅助运动区和运动前区。对于RHD，仅检测到颞叶、额叶和岛叶皮质的部分区域以及扣带回至关重要。在两个半球均检测到皮质下脑结构（基底神经节、放射冠、内囊和上纵束）。
尽管不同的LSM方法之间存在差异，但所有方法均一致显示LHD与RHD后上肢功能关键脑区之间存在差异。这些发现支持了先前的研究结果，即左（运动优势）半球的相互连接性更强，因此具有更高的冗余度且对局灶性损伤的易感性更低。
