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  Multimodal assessment of the motor system in patients with chronic ischemic stroke

Nazarova, M., Kulikova, S., Piradov, M. A., Limonova, A. S., Dobrynina, L. A., Konovalov, R. N., et al. (2021). Multimodal assessment of the motor system in patients with chronic ischemic stroke. Stroke, 52(1), 241-249. doi:10.1161/STROKEAHA.119.028832.

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Nazarova, Maria1, 2, Author
Kulikova, Sofya3, Author
Piradov, Michael A.4, Author
Limonova, Alena S.5, Author
Dobrynina, Larisa A.4, Author
Konovalov, Rodion N.4, Author
Novikov, Pavel A.1, Author
Sehm, Bernhard6, 7, Author              
Villringer, Arno7, 8, Author              
Saltykova, Anastasia3, Author
Nikulin, Vadim V.1, 7, Author              
1Centre for Cognition and Decision Making, National Research University Higher School of Economics, Moscow, Russia, ou_persistent22              
2Federal Medical-Biological Agency (FMBA), Moscow, Russia, ou_persistent22              
3Higher School of Economics Perm, Russia, ou_persistent22              
4Research Center of Neurology, Moscow, Russia, ou_persistent22              
5National Medical Research Center for Therapy & Preventive Medicine, Moscow, Russia, ou_persistent22              
6Department of Neurology, Martin Luther University Halle-Wittenberg, Germany, ou_persistent22              
7Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_634549              
8Clinic for Cognitive Neurology, University of Leipzig, Germany, ou_persistent22              


Free keywords: Corticospinal tract; Transcranial magnetic stimulation; Corpus callosum; Ischemic chronic stroke; Upper limb paresis; Motor cortex; Diffusion-weighted imaging
 Abstract: Background and Purpose: Despite continuing efforts in the multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the ipsilesional corticospinal tract integrity and the role of the contralesional hemisphere are still lacking. This research aimed to find the best combination of motor system metrics, allowing the classification of patients into 3 predefined groups of upper limb motor recovery. Methods: We enrolled 35 chronic ischemic stroke patients (mean 47 [26–66] years old, 29 [6–58] months poststroke) with a single supratentorial lesion and unilateral upper extremity weakness. Patients were divided into 3 groups, depending on upper limb motor recovery: good, moderate, and bad. Nonparametric statistical tests and regression analysis were used to investigate the relationships among microstructural (fractional anisotropy (FA) ratio of the corticospinal tracts at the internal capsule (IC) level (classic method) and along the length of the tracts (Fréchet distance), and of the corpus callosum) and functional (motor evoked potentials [MEPs] for 2 hand muscles) motor system metrics. Stratification rules were also tested using a decision tree classifier. Results: IC FA ratio in the IC and MEP absence were both equally discriminative of the bad motor outcome (96% accuracy). For the 3 recovery groups’ classification, the best parameter combination was IC FA ratio and the Fréchet distance between the contralesional and ipsilesional corticospinal tract FA profiles (91% accuracy). No other metrics had any additional value for patients’ classification. MEP presence differed for 2 investigated muscles. Conclusions: This study demonstrates that better separation between 3 motor recovery groups may be achieved when considering the similarity between corticospinal tract FA profiles along its length in addition to region of interest-based assessment and lesion load calculation. Additionally, IC FA ratio and MEP absence are equally important markers for poor recovery, while for MEP probing it may be important to investigate more than one hand muscle.


Language(s): eng - English
 Dates: 2020-07-132019-12-202020-10-052020-12-152021-01
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.1161/STROKEAHA.119.028832
Other: ePub 2020
PMID: 33317414
 Degree: -



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Title: Stroke
Source Genre: Journal
Publ. Info: Philadelphia, PA : Lippincott Williams & Wilkins
Pages: - Volume / Issue: 52 (1) Sequence Number: - Start / End Page: 241 - 249 Identifier: ISSN: 0039-2499
CoNE: https://pure.mpg.de/cone/journals/resource/954925447729