Ann Rehabil Med.
2012 Aug;36(4):501-511. 10.5535/arm.2012.36.4.501.
Prediction of Motor Function Recovery after Subcortical Stroke: Case Series of Activation PET and TMS Studies
- Affiliations
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- 1Department of Rehabilitation Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 156-707, Korea.
- 2Department of Nuclear Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 156-707, Korea.
- 3Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
- 4Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea. njpaik@snu.ac.kr
- KMID: 2266721
- DOI: http://doi.org/10.5535/arm.2012.36.4.501
Abstract
OBJECTIVE
To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke. METHOD: Ten patients with first-ever subcortical stroke (55.7+/-17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7+/-25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau.
RESULTS
The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facilitation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery.
CONCLUSION
Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery significantly.
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