Li Ran, Wang Yong, Li Haimei, Liu Jie, Liu Sujuan
Department of Rehabilitation Center, Fu Xing Hospital, Capital Medical University, 20#, Fu Xing Men Wai Street, Beijing, 100038, China.
Brain Imaging Behav. 2024 Dec;18(6):1549-1559. doi: 10.1007/s11682-024-00917-3. Epub 2024 Oct 7.
Changes in cortical excitability after stroke are closely associated with motor function recovery. This study aimed to clarify the motor network reorganization mechanisms corresponding to the different clinical outcomes of upper limb motor impairment in patients with subacute stroke. Motor function was assessed before rehabilitation (pre), after rehabilitation (post), and at the 1-year follow-up (follow-up) using the Fugl-Meyer assessment upper extremity scale. Further, resting-state functional magnetic resonance imaging (fMRI) data were collected in both pre- and post-conditions. Twenty patients with stroke were categorized into good and poor outcome groups based on motor impairments at the 1-year follow-up. Functional connections between motor-related regions of interest and the rest of the brain were subsequently calculated. Finally, the correlation between motor network reorganization and behavioral improvement at the 1-year follow-up was analyzed. The good outcome group exhibited a positive precondition motor function and continuous improvement, whereas the poor outcome group showed a weak precondition motor function and insignificant improvement. Contralesional hemisphere-related connections were found to be higher in the good outcome group pre-conditioning, with both groups showing minimal change post-conditioning, while no relationship with motor impairment was found. Long interhemispheric connections were decreased and increased in the good and poor outcome groups respectively, and were negatively correlated with motor impairment. Different motor network reorganizations during the subacute phase can influence the varying motor outcomes in the affected upper limb after stroke. These findings may serve as the theoretical basis for future neuromodulatory research.
中风后皮质兴奋性的变化与运动功能恢复密切相关。本研究旨在阐明亚急性中风患者上肢运动障碍不同临床结局所对应的运动网络重组机制。使用Fugl-Meyer评估上肢量表在康复前（pre）、康复后（post）以及1年随访时（follow-up）评估运动功能。此外，在康复前和康复后两种情况下均收集静息态功能磁共振成像（fMRI）数据。根据1年随访时的运动障碍情况，将20例中风患者分为良好结局组和不良结局组。随后计算感兴趣的运动相关区域与大脑其他区域之间的功能连接。最后，分析1年随访时运动网络重组与行为改善之间的相关性。良好结局组在康复前运动功能良好且持续改善，而不良结局组康复前运动功能较弱且改善不明显。在良好结局组康复前，发现对侧半球相关连接较高，两组在康复后变化均最小，且未发现与运动障碍有关。在良好结局组和不良结局组中，半球间长连接分别减少和增加，且与运动障碍呈负相关。亚急性期不同的运动网络重组可影响中风后受累上肢不同的运动结局。这些发现可为未来的神经调节研究提供理论基础。
