Differential early predictive factors for upper and lower extremity motor recovery after ischaemic stroke. (27th September 2020)

• Record Type: Journal Article
• Authors: Lee, J.; Kim, H.; Kim, J.; Lee, H.‐J.; Chang, W. H.; Kim, Y.‐H.
• Is Part Of: European journal of neurology. Volume 28:Number 1(2021)
• Page Start: 132
• Page End: 140
• Publication Date: 2020-09-27
• Subjects: cerebral infarction -- lower extremity -- neuroimaging -- recovery of function -- stroke -- upper extremity; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.14494
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract : Background and purpose: Various clinical and neuroimaging predictive factors have been identified for the recovery of upper extremity (UE) motor function after stroke. However, few studies have addressed factors related to the recovery of lower extremity (LE) motor function after stroke or performed direct comparisons of UE and LE motor recovery in the same set of patients. In this study, predictive factors for UE and LE motor recovery after stroke were investigated using clinical and neuroimaging characteristics. Methods: Forty‐two subacute ischaemic stroke patients underwent structural and functional magnetic resonance imaging data acquisition and cognitive/behavioral assessments using the Fugl–Meyer assessment, the National Institutes of Health Stroke Scale (NIHSS) and the Mini‐Mental State Examination (MMSE) 2 weeks after stroke onset. Neuroimaging factors, including corticospinal tract (CST) fractional anisotropy, lesion volume, CST lesion load and interhemispheric homotopic functional connectivity, were extracted. The outcome of motor function was assessed by Fugl–Meyer assessment scores 3 months after onset. Results: Early clinical and neuroimaging factors for predicting motor recovery were noticeably different for UE and LE. UE motor function recovery was related to age, NIHSS, MMSE, CST lesion load, lesion volume, ipsilesional CST integrity and interhemispheric homotopic functional connectivity. In contrast, LE motor recovery was related to ipsilesional and contralesional CST integrity and MMSE. Specifically, LE recovery showed a strong relationship to the preservation of cognitive function compared with motor impairment. Conclusions: Our results indicate that different mechanisms underlie UE and LE motor recovery after stroke. LE motor recovery seems to be more intensively modulated by cognitive functions than UE. Abstract : No early factors for predicting motor recovery after stroke are noticeably different for upper and lower extremities. Upper extremity recovery is related to damage to the ipsilesional corticospinal tract and lesion volume. In contrast, lower extremity recovery is related to damage to the bilateral corticospinal tract and the proposed novel factor which is the normalized difference between early cognitive and motor function impairment. Lower extremity recovery is more strongly modulated by the relationship between motor and non‐motor functions compared with upper extremity recovery.