Zich Catharina, Ward Nick S, Forss Nina, Bestmann Sven, Quinn Andrew J, Karhunen Eeva, Laaksonen Kristina
Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, United Kingdom; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Medical Research Council Brain Network Dynamics Unit, University of Oxford, United Kingdom.
Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, United Kingdom.
Neuroimage Clin. 2025;45:103754. doi: 10.1016/j.nicl.2025.103754. Epub 2025 Feb 13.
Improving outcomes after stroke depends on understanding both the causes of initial function/impairment and the mechanisms of recovery. Recovery in patients with initially low function/high impairment is variable, suggesting the factors relating to initial function/impairment are different to the factors important for subsequent recovery. Here we aimed to determine the contribution of altered brain structure and function to initial severity and subsequent recovery of the upper limb post-stroke. The Nine-Hole Peg Test was recorded in week 1 and one-month post-stroke and used to divide 36 stroke patients (18 females, age: M = 66.56 years) into those with high/low initial function and high/low subsequent recovery. We determined differences in week 1 brain structure (Magnetic Resonance Imaging) and function (Magnetoencephalography, tactile stimulation) between high/low patients for both initial function and subsequent recovery. Lastly, we examined the relative contribution of changes in brain structure and function to recovery in patients with low levels of initial function. Low initial function and low subsequent recovery are related to lower sensorimotor β power and greater lesion-induced disconnection of contralateral [ipsilesional] white-matter motor projection connections. Moreover, differences in intra-hemispheric connectivity (structural and functional) are unique to initial motor function, while differences in inter-hemispheric connectivity (structural and functional) are unique to subsequent motor recovery. Function-related and recovery-related differences in brain function and structure after stroke are related, yet not identical. Separating out the factors that contribute to each process is key to identifying potential therapeutic targets for improving outcomes.
改善中风后的预后取决于对初始功能/损伤的原因以及恢复机制的理解。初始功能低/损伤高的患者恢复情况各不相同，这表明与初始功能/损伤相关的因素与后续恢复的重要因素不同。在此，我们旨在确定脑结构和功能改变对中风后上肢初始严重程度和后续恢复的影响。在中风后第1周和1个月记录九孔插钉试验，并用于将36名中风患者（18名女性，年龄：M = 66.56岁）分为初始功能高/低和后续恢复高/低的患者。我们确定了初始功能和后续恢复的高/低患者在第1周脑结构（磁共振成像）和功能（脑磁图，触觉刺激）方面的差异。最后，我们研究了脑结构和功能变化对初始功能水平低的患者恢复的相对影响。初始功能低和后续恢复低与较低的感觉运动β功率以及病变引起的对侧[同侧]白质运动投射连接的更大断开有关。此外，半球内连接性（结构和功能）的差异是初始运动功能所特有的，而半球间连接性（结构和功能）的差异是后续运动恢复所特有的。中风后脑功能和结构中与功能相关和与恢复相关的差异是相关的，但并不相同。区分促成每个过程的因素是确定改善预后的潜在治疗靶点的关键。
