key word: stroke AND motor AND brain AND review in google scholar
key key word: Plasticity,
Plasticity of the human motor cortex and recovery from stroke
- Studies with TMS have not confirmed the utility of ipsilateral pathways for recovery when stroke occurs in adult age. Some studies do show that ipsilateral MEPs are more likely, have lower threshold and have shorter latency in patients with stroke than normal subjects. However, these responses are found more frequently in patients with poorer functional recovery.
Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults
- In fully recovered patients with striatocapsular infarction, the findings have consistently showed (1) enhanced bilateral activation of motor pathways, not clearly related to mirror movements; (2) recruitment of additional sensory and secondary motor structures not normally involved in the motor tasks tested; and (3) extension of SM1 activation toward the face area.
- the findings from longitudinal studies of subcortical stroke are consistent with those from cross-sectional studies, especially in showing overrecruiting of motor and nonmotor areas in both hemispheres regardless of whether the task is active or passive.
- a common observation is that there is less overrecruitment in both hemispheres over time, although with individual variability.
- In contrast, structures such as the contralesional PM tend to develop a late overactivation, consistent with cross-sectional studies performed in the chronic stage.
- In one study, different patterns of dynamic evolution of activation were observed over time, including a “focalization” of ipsilesional SM1 found either at the first fMRI (consistently in subcortical stroke) or progressing over time (mainly in subcortical stroke) and a “recruitment” pattern with activation predominantly outside the ipsilesional SM1 (mainly seen in cortical stroke).
- (1) displacement/extension of affected-side SM1 activation, ie, caudal and posterior in subcortical stroke and infarct rim in cortical stroke; (2) bilaterality of SM1 activation; (3) increased activity in primary and secondary motor areas, eg, in the bilateral PM in the late phase of recovery, as well as in some nonmotor areas, eg, late prefrontal activation; (4) shifts of activation balance between the affected and unaffected hemispheres as recovery takes place, together with decreasing amount of overactivated voxels on both sides; (5) better recovery from subcortical stroke if affected-side activation becomes predominant over time; and (6) parallel enhancement of motor performance and affected-side SM1 activation by intensive rehabilitation training and fluoxetine.
- Another interesting finding concerns the recruitment of areas normally not engaged in the execution of a motor task—unless the latter has particular complexity or nonmotor components—such as the prefrontal, posterior parietal, and anterior cingulate cortices and the insula
- overactivated after stroke is the basal ganglia, whose physiological role in motor control remains uncertain, although they appear to be particularly involved during motor skill learning.
- Interestingly, the fact that passive movements seem to have similar use-dependent effects on the ipsilesional SM1.
- Moving the hand involves not only the precentral motor strip but also a number of additional areas, such as the PM, SMA, and cingulate motor area.
- functionally distinct subdivisions within these motor areas have been described, notably the dorsal and ventral PM, the rostral and caudal SMA (pre-SMA and SMA-proper, respectively), and the anterior and posterior rostral cingulate motor area.
- There are considerable connections between the primary motor cortex (M1) and the primary somatosensory cortex (S1), as well as between the 2 hemispheres.
- In addition, the motor cortices have strong connections with the ipsilateral basal ganglia and the thalamus as well as with the contralateral cerebellum, according to well-described circuits.
Motor rehabilitation and brain plasticity after hemiparetic stroke
- TMS studies have observed early abnormalities in the excitability of ipsilesional motor cortex that tend to wane over time in association with motor recovery.
- Several functional neuroimaging studies suggest that activity within the sensorimotor network, not exclusively ipsilesional motor cortex, is most abnormal early after hemiparetic stroke, and that motor recovery is related to normalization of its activity.
- Cumulatively, these studies suggest that normalization of activation in the sensorimotor network, following early excessive activation, is generally linked to better motor recovery after stroke.
- In a serial study, Feydy et al. (2002) observed that during the first 6 months after stroke when patients exhibited some degree of motor recovery, those with a lesion that included primary motor cortex tended to exhibit persistent activation in bilateral sensorimotor cortices, whereas those with a lesion that spared primary motor cortex tended to return to the normal laterality of sensorimotor cortex activation.
- explored neural correlates of motor recovery in patients with stroke by investigating longitudinal changes in resting-state functional connectivity of the ipsilesional primary motor cortex (M1)
- 12 patients with stroke, resting-state fMRI data, 4 times over a period of 6 months.
- Patients participated in the first session of fMRI shortly after onset and thereafter in subsequent sessions at 1, 3, and 6 months after onset.
- compared with that of healthy subjects.
- Results:
- patients demonstrated higher functional connectivity with the ipsilesional frontal and parietal cortices, bilateral thalamus, and cerebellum.
- functional connectivity with the contralesional M1 and occipital cortex were decreased in patients
- Functional connectivity of the ipsilesional M1 with the contralesional thalamus, supplementary motor area, and middle frontal gyrus at onset was positively correlated with motor recovery at 6 months after stroke.
- it is conceivable that connectivity of the ipsilesional M1 increased within ipsilesional brain regions, whereas it decreased within contralesional brain regions.
Motor Control and Neural Plasticity through Interhemispheric Interactions
- it may be more efficient to use one hemisphere and inhibit the other hemisphere during simple tasks (e.g., physical identity and face-matching tasks); this promotes intrahemispheric processing and brain lateralization.
- Research on the functions of interhemispheric interactions is based on studies of brain lateralization, which is thought to allow each hemisphere to process information without the interference of the contralateral hemisphere.
- Several studies have reported that stroke lesions indirectly disrupt interhemispheric interactions
- This abnormal adjustment of interhemispheric inhibition correlates with motor function deficits, strongly suggesting that altered interhemispheric interactions can result in motor deficits in patients with stroke.
- a relation between excessive interhemispheric inhibition from the contralesional motor cortex and motor impairment has been reported mainly in patients with chronic subcortical stroke and during movement.
- The interhemispheric interaction may vary depending on the stage of the stroke, the site of the lesion, and movement conditions
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