Ann Rehabil Med.  2017 Dec;41(6):905-914. 10.5535/arm.2017.41.6.905.

Neural Correlates of Motor Recovery Measured by SPECT at Six Months After Basal Ganglia Stroke

• Choi JW
• Kim MH
• Park SA
• Sin DS
• Kim MS

• KMID: 2400274
• DOI: http://doi.org/10.5535/arm.2017.41.6.905

Abstract

OBJECTIVE
To investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT).
METHODS
Medical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function.
RESULTS
After ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041).
CONCLUSION
CVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.

Keyword

Acetazolamide; Basal ganglia; Recovery of function; Stroke; Single photon emission computed tomography

MeSH Terms

Acetazolamide
Basal Ganglia*
Brain
Cerebrovascular Circulation
Cerebrum
Humans
Medical Records
Motor Cortex
Multivariate Analysis
Occipital Lobe
Parietal Lobe
Prefrontal Cortex
Recovery of Function
Retrospective Studies
Stroke*
Temporal Lobe
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon*
Acetazolamide

Figure

• 

  Fig. 1 Measurement of the baseline cerebral blood flow in each region of interest (ROI) using SPECT. ROIs on the axial, coronal, and sagittal images were recognized, and then the counts per pixel of ROIs were quantitatively measured and averaged. Finally, the mean counts per pixel were normalized versus the total counts for the brain. (A) Basal ganglia. (B) Primary motor cortex.

• 

  Fig. 2 Calculation of the cerebrovascular reserve (CVR). After acetazolamide injection, CVR was measured as a percentage of the recovery of the blood flow relative to the baseline. (A) There are areas of severe hypoperfusion in the left basal ganglia at baseline. (B) After injection, a significant improvement of perfusion was demonstrated, suggesting preserved CVR.

• 

  Fig. 3 Neural correlates of motor recovery 6 months post-BG stroke. The restoration of blood flow in bilateral primary motor cortex and ipsilateral parietal lobe were significantly related to the improvement of upper motor function. (A) Ipsilateral primary motor cortex. (B) Ipsilateral parietal lobe. (C) Contralateral primary motor cortex. BG, basal ganglia; CVR, cerebrovascular reserve; FMA, Fugl-Meyer Assessment.

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