Recruitment of contralesional motor cortex in stroke patients with recovery of hand function

Bütefisch, Cathrin M.; Kleiser, Raimund; Körber, Barbara; Müller, Katharina; Wittsack, Hans‐Jörg; Hömberg, V.; Seitz, Rüdiger J.

doi:10.1212/01.wnl.0000154603.48446.36

Cited by 113 publications

(102 citation statements)

References 5 publications

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“…It seems that the system is somehow "upregulated" for execution of any movement and it is possible that such an increase in neural activity is essential to send sufficient signal to the motor neurons downstream. More activation in the sensorimotor cortex, SMA and cerebellum also reinforces the idea that increased reliance on brain structures involved in motor control may be an integral part of reorganization of motor systems (Bütefisch et al, 2005).…”

Section: Discussionsupporting

confidence: 61%

Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients

et al. 2007

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We studied motor representation in patients who recovered well following a stroke. Eighteen righthanded stroke patients and eleven age-matched control subjects underwent functional Magnetic Resonance Imaging (fMRI) while performing unimanual index finger (abduction-adduction) and wrist movements (flexion-extension) using their recovered and non-affected hand. A subset of these patients underwent Transcranial Magnetic Stimulation (TMS) to elicit motor evoked potentials (MEP) in the first dorsal interosseous muscle of both hands. Imaging results suggest that good recovery utilizes both ipsi-and contralesional resources, although results differ for wrist and index finger movements. Wrist movements of the recovered arm resulted in significantly greater activation of the contralateral (lesional) and ipsilateral (contralesional) primary sensorimotor cortex (SM1), while comparing patients to control subjects performing the same task. In contrast, recovered index finger movements recruited a larger motor network, including the contralateral SM1, Supplementary Motor Area (SMA) and cerebellum when patients were compared to control subjects. TMS of the lesional hemisphere but not of the contralesional hemisphere induced MEPs in the recovered hand. TMS parameters also revealed greater transcallosal inhibition, from the contralesional to the lesional hemisphere than in the reverse direction. Disinhibition of the contralesional hemisphere observed in a subgroup of our patients suggests persistent alterations in intracortical and transcallosal (interhemispheric) interactions, despite complete functional recovery.

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Section: Discussionsupporting

confidence: 61%

Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients

et al. 2007

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“…6 -8 These studies are limited by the types of sensory or motor activation paradigms that can be performed during scanning; other studies suggest that alternative recovery patterns may be present. 9 However, similar data have been obtained after functional recovery from hemispatial neglect 10 and aphasia, 11,12 in which recovery is associated with a reorganization of cortical activity over time in a network of areas ipsilateral to the lesion. Similarly, transcranial magnetic stimulation mapping studies indicate that stroke induces new movement representations in periinfarct motor cortex, which correlate with functional recovery.…”

Section: Patterns Of Recovery In the Human Brain After Stroke: Periinmentioning

confidence: 54%

Cellular and molecular mechanisms of neural repair after stroke: Making waves

Carmichael

2006

Annals of Neurology

530

451

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Stroke is associated with a limited degree of functional recovery. Imaging studies in humans have shown that reorganization in periinfarct and connected cortical areas most closely correlates with functional recovery after stroke. On a cellular level, two major regenerative events occur in periinfarct cortex: axons sprout new connections and establish novel projection patterns, and newly born immature neurons migrate into periinfarct cortex. Stroke induces a unique microenvironment for axonal sprouting in periinfarct cortex, in which growth-inhibitory molecules are reduced for 1 month after the infarct. During this period, neurons activate growth-promoting genes in successive waves. Neurogenesis also occurs through waves of migration of immature neurons from their origin in the subventricular zone into periinfarct cortex. This migration is mediated, in part, by the cytokine erythropoietin. These data indicate that the cellular environment after stroke is far from one of just death and destruction, but rather involves a longer evolving process of neuronal regeneration. Poststroke neuronal regeneration is characterized by waves of specific cellular and molecular events. Manipulating these waves of regeneration may provide for novel therapies that will improve recovery after stroke.

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“…44. Briefly, EMG was recorded from the abductor hallucis (AH) and the first dorsal interosseus (FDI) muscles.…”

Section: Methodsmentioning

confidence: 99%

“…Based on these averages, the ratio between activation and rest was calculated for left and right AH and FDI muscles (44).…”

Section: Methodsmentioning

confidence: 99%

Congenitally altered motor experience alters somatotopic organization of human primary motor cortex

Stoeckel

Seitz

Buetefisch

2009

Proc. Natl. Acad. Sci. U.S.A.

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Human motor development is thought to result from a complex interaction between genes and experience. The well-known somatotopic organization of the primate primary motor cortex (M1) emerges postnatally. Although adaptive changes in response to learning and use occur throughout life, somatotopy is maintained as reorganization is restricted to modifications within major body part representations. We report of a unique opportunity to evaluate the influence of experience on the genetically determined somatotopic organization of motor cortex in humans. We examined the motor "foot" representation in subjects with congenitally compromised hand function and compensatory skillful foot use. Functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) of M1 revealed that the foot was represented in the classical medial foot area of M1 and was several centimetres away in nonadjacent cortex in the vicinity of the lateral ''hand'' area. Both areas had direct output to the spinal motor neurons innervating foot muscles and were behaviorally relevant because experimental disruption of either area by TMS altered reaction times. We demonstrate a unique, nonsomatotopically organized M1 in humans, which emerged as a function of grossly altered motor behavior from the earliest stages of development. Our results imply that during early motor development experience may play a more critical role in the shaping of genetically determined neural networks than previously assumed.fMRI ͉ motor development ͉ motor plasticity ͉ nonsomatotopic ͉ TMS

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Recruitment of contralesional motor cortex in stroke patients with recovery of hand function

Cited by 113 publications

References 5 publications

Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients

Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients

Cellular and molecular mechanisms of neural repair after stroke: Making waves

Congenitally altered motor experience alters somatotopic organization of human primary motor cortex

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