Pathophysiology of Stroke Rehabilitation: Temporal Aspects of Neurofunctional Recovery

Kreisel, Stefan H.; Bäzner, Hansjörg; Hennerici, Michael G.

doi:10.1159/000089588

Cited by 65 publications

(58 citation statements)

References 188 publications

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“…19 Seven-day NIHSS change was used to examine the early neurological improvement. The cutoff (0 to 2 versus 3 to 6) of 90-day mRS was chosen as indicated in the primary report of ECASS-II.…”

Section: Discussionmentioning

confidence: 99%

Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial

Mei

Kaste

2008

Stroke

193

153

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Background and Purpose-Baseline hyperglycemia has been considered an independent predictor of stroke outcome. The present study analyzes the dynamics of serum glucose levels within the first 24 hours and its impact on stroke outcome. Methods-We studied 748 patients with acute ischemic hemispheric stroke in the second European Cooperative Acute Stroke Study (ECASS-II). The patients had 2 serum glucose measurements, at baseline and at 24 hours. Four dynamic patterns were defined as baseline hyperglycemia present only at baseline, 24-hour hyperglycemia present only at 24 hours, persistent hyperglycemia, ie, hyperglycemia at baseline and at 24 hours, and persistent normoglycemia, ie, normoglycemia at baseline and at 24 hours. The end points were 7-day neurological improvement on National Institutes

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Section: Discussionmentioning

confidence: 99%

Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial

Mei

Kaste

2008

Stroke

193

153

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“…For example, inflammatory markers after stroke are associated with increased lymphocyte infiltration and poorer recovery of brain tissue in experimental stroke, 18 the release of excitatory neurotransmitters such as glutamate as part of the ischemic cascade can increase apoptosis and neuronal and glial death, 19 and higher levels of anti-inflammatory markers might indicate strengthened intrinsic antiatherosclerotic mechanisms. Increases in neurotrophic or neuroprotective markers may be associated with improved neuronal recovery.…”

Section: Stroke Recoverymentioning

confidence: 99%

Blood Markers for the Prognosis of Ischemic Stroke

Whiteley

Chong

Sengupta

et al. 2009

Stroke

272

204

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Background and Purpose-The performance of validated prognostic clinical models in acute ischemic stroke might be improved by addition of data on blood biomarkers. Methods-We searched Medline and EMBASE from 1966 to January 2007 for studies of blood markers in patients with ischemic stroke and an assessment of outcome (death, disability, or handicap). We adopted several strategies to reduce bias. Results-Studies were generally small (median number of subjects, 85; interquartile range, 49 to 184). Few had evidence of a sample size calculation (7 of 82 [9%]) or reported blinding to whether patients had stroke (21 of 82 [26%]). Of the 66 studies reporting a measure of association, 10 did not adjust for age or stroke severity, 14 adjusted for age, 7 adjusted for severity, and 35 adjusted for both; 30% (20 of 66) used a data-dependent threshold to predict good or bad outcome. There was evidence of within-study reporting bias and publication bias. Cardiac markers showed the most consistent association with poor outcome. Conclusions-Blood biomarkers might provide useful information to improve the prediction of outcome after acute ischemic stroke. However, this review showed that many studies were subject to bias. Although some markers had some predictive ability, none of the studies was able to demonstrate that the biomarker added predictive power to a validated clinical model. The clinical usefulness of blood biomarkers for predicting prognosis in the setting of ischemic stroke has yet to be established. (Stroke. 2009;40:e380-e389.)

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“…Spontaneous restitution of lost function after stroke has been associated with brain plasticity, which refers to the ability of the brain to compensate for loss of function through reorganization of neuronal networks. Functional and structural brain reorganization after stroke has been demonstrated in several animal and human studies (for review, see Nudo, 1999;Kreisel et al, 2006). In recent years, neuroimaging modalities, in particular functional magnetic resonance imaging (fMRI), have been successfully applied to in vivo, whole-brain assessment of changes in functional activation patterns in stroke patients (Cramer and Bastings, 2000;Rijntjes and Weiller, 2002;Calautti and Baron, 2003) and experimental stroke models (Dijkhuizen et al, 2001(Dijkhuizen et al, , 2003Weber et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Recovery of Sensorimotor Function after Experimental Stroke Correlates with Restoration of Resting-State Interhemispheric Functional Connectivity

Meer

Marel²,

Wang³

et al. 2010

J. Neurosci.

308

289

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Despite the success of functional imaging to map changes in brain activation patterns after stroke, spatiotemporal dynamics of cerebral reorganization in correlation with behavioral recovery remain incompletely characterized. Here, we applied resting-state functional magnetic resonance imaging (rs-fMRI) together with behavioral testing to longitudinally assess functional connectivity within neuronal networks, in relation to changes in associated function after unilateral stroke in rats. Our specific goals were (1) to identify temporal alterations in functional connectivity within the bilateral cortical sensorimotor system and (2) to elucidate the relationship between those alterations and changes in sensorimotor function. Our study revealed considerable loss of functional connectivity between ipsilesional and contralesional primary sensorimotor cortex regions, alongside significant sensorimotor function deficits in the first days after stroke. The interhemispheric functional connectivity restored in the following weeks, but remained significantly reduced up to 10 weeks after stroke in animals with lesions that comprised subcortical and cortical tissue, whereas transcallosal neuroanatomical connections were preserved. Intrahemispheric functional connectivity between primary somatosensory and motor cortex areas was preserved in the lesion border zone and moderately enhanced contralesionally. The temporal pattern of changes in functional connectivity between bilateral primary motor and somatosensory cortices correlated significantly with the evolution of sensorimotor function scores. Our study (1) demonstrates that poststroke loss and recovery of sensorimotor function is associated with acute deterioration and subsequent retrieval of interhemispheric functional connectivity within the sensorimotor system and (2) underscores the potential of rs-fMRI to assess spatiotemporal characteristics of functional brain reorganization that may underlie behavioral recovery after brain injury.

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Pathophysiology of Stroke Rehabilitation: Temporal Aspects of Neurofunctional Recovery

Cited by 65 publications

References 188 publications

Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial

Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial

Blood Markers for the Prognosis of Ischemic Stroke

Recovery of Sensorimotor Function after Experimental Stroke Correlates with Restoration of Resting-State Interhemispheric Functional Connectivity

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