Neurophysiological Characterization of Subacute Stroke Patients: A Longitudinal Study

Lamola, Giuseppe; Fanciullacci, Chiara; Sgherri, Giada; Bertolucci, Federica; Panarese, Alessandro; Micera, Silvestro; Rossi, Bruno; Chisari, Carmelo

doi:10.3389/fnhum.2016.00574

Cited by 13 publications

(8 citation statements)

References 38 publications

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“…The present study importantly described that the pdBSI index could be explicative of neurological status only in subcortical stroke and highlighted the direct relation between brain post lesional reorganization and functional status in this type of lesions. This result is in agreement with previous studies, which described the relation between subcortical lesion and clinical status, with a specific involvement of UH activity (Thickbroom et al, 2015 ; Lamola et al, 2016 ). One of these studies showed a direct correlation between the UH excitability and the clinical scales in the subacute stroke phase (Thickbroom et al, 2015 ).…”

Section: Discussionsupporting

confidence: 94%

“…One of these studies showed a direct correlation between the UH excitability and the clinical scales in the subacute stroke phase (Thickbroom et al, 2015 ). Moreover, the reduction of unaffected intracortical inhibition in subcortical stroke patients played an important role in effective motor recovery at 3 months after the acute event (Lamola et al, 2016 ). While these studies described the role of motor cortex and cortico-spinal tract in motor function, the innovative result of our study is the description of the specific bilateral process in subcortical stroke involved in the patients’ functional status by means of electrical cortical activity analysis.…”

Section: Discussionmentioning

confidence: 99%

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Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement

Fanciullacci

Bertolucci

Lamola

et al. 2017

Front. Hum. Neurosci.

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A brain injury resulting from unilateral stroke critically alters brain functionality and the complex balance within the cortical activity. Such modifications may critically depend on lesion location and cortical involvement. Indeed, recent findings pointed out the necessity of applying a stratification based on lesion location when investigating inter-hemispheric balance in stroke. Here, we tested whether cortical involvement could imply differences in band-specific activity and brain symmetry in post stroke patients with cortico-subcortical and subcortical strokes. We explored brain activity related to lesion location through EEG power analysis and quantitative Electroencephalography (qEEG) measures. Thirty stroke patients in the subacute phase and 10 neurologically intact age-matched right-handed subjects were enrolled. Stroke patients were equally subdivided in two groups based on lesion location: cortico-subcortical (CS, mean age ± SD: 72.21 ± 10.97 years; time since stroke ± SD: 31.14 ± 11.73 days) and subcortical (S, mean age ± SD: 68.92 ± 10.001 years; time since stroke ± SD: 26.93 ± 13.08 days) group. We assessed patients’ neurological status by means of National Institutes of Health Stroke Scale (NIHSS). High density EEG at rest was recorded and power spectral analysis in Delta (1–4 Hz) and Alpha (8–14 Hz) bands was performed. qEEG metrics as pairwise derived Brain Symmetry Index (pdBSI) and Delta/Alpha Ratio (DAR) were computed and correlated with NIHSS score. S showed a lower Delta power in the Unaffected Hemisphere (UH) compared to Affected Hemisphere (AH; z = −1.98, p < 0.05) and a higher Alpha power compared to CS (z = −2.18, p < 0.05). pdBSI was negatively correlated with NIHSS (R = −0.59, p < 0.05). CS showed a higher value and symmetrical distribution of Delta band activity (z = −2.37, p < 0.05), confirmed also by a higher DAR value compared to S (z = −2.48, p < 0.05). Patients with cortico-subcortical and subcortical lesions show different brain symmetry in the subacute phase. Interestingly, in subcortical stroke patient brain activity is related with the clinical function. qEEG measures can be explicative of brain activity related to lesion location and they could allow precise definition of diagnostic-therapeutic algorithms in stroke patients.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement

Fanciullacci

Bertolucci

Lamola

et al. 2017

Front. Hum. Neurosci.

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“…For instance, patients with severe paresis (MSC muscle score 0–1) of the upper extremity, who experience motor recovery, are likely to have an early AMP improvement, even when clinical examination cannot be detected for motor recovery ( 35 ). Besides, some studies show that TMS parameters are more sensitive in longer follow-up periods in terms of motor function recovery in patients with acute ischemic stroke ( 36 ). In this study, there seemed to be a clear association between AMP and motor recovery than CMCT and RMT in a two-week rehabilitation therapy—an observation that indicated the superior predictive ability of AMP for functional recovery over a short time period.…”

Section: Discussionmentioning

confidence: 99%

Short-term Efficacy of Hand-Arm Bimanual Intensive Training on Upper Arm Function in Acute Stroke Patients: A Randomized Controlled Trial

Meng

Meng²,

Tan

et al. 2018

Front. Neurol.

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BackgroundRehabilitation training during the acute phase of stroke (<48 h) markedly improves impaired upper-limb movement. Hand-arm bimanual intensive training (HABIT) represents an intervention that promotes improvements in upper extremity function in children with cerebral palsy. This study repurposed HABIT in acute stroke patients and assessed recovery of upper extremity function when compared with a conventional rehabilitation program (CRP).MethodsIn a randomized trial, 128 patients with acute stroke were assigned to the HABIT or the CRP groups. The primary endpoint was clinical motor functional assessment that was guided by the Fugl-Meyer motor assessment (FMA) and outcomes of the action research arm test (ARAT). The secondary endpoint was an improved neurophysiological evaluation according to the motor-evoked potential amplitude (AMP), resting motion threshold (RMT), and central motor conduction time (CMCT) scores over the 2-week course of therapy. In both groups, scores were evaluated at baseline, 1 week from commencing therapy, and post-therapy.ResultsAfter 2 weeks, the HABIT group showed improved scores as compared the CRP group for FMA (51.7 ± 6.44 vs. 43.5 ± 5.6, P < 0.001), ARAT (34.5 ± 6.2 vs. 33.3 ± 6.3, P = 0.022), and AMP (1.1 ± 0.1 vs. 1.0 ± 0.1, P < 0.001). However, CMCT (8.6 ± 1.0 vs. 9.1 ± 0.6, P = 0.054) and RMT (55.3 ± 4.2 vs. 57.5 ± 4.1, P = 0.088) were similar when comparing between groups.ConclusionHABIT significantly improved motor functional and neuro-physiological outcomes in patients with acute stroke, which suggested that HABIT might represent an improved therapeutic strategy as compared CRP.

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“…Recent findings based on TMS, fMRI and EEG studies pointed out that cortico-subcortical and subcortical stroke patients have different cortical activity and excitability levels of the motor cortex ( Luft et al, 2004 ; Thickbroom et al, 2015 ; Lamola et al, 2016 ; Fanciullacci et al, 2017 ; Sarasso et al, 2020 ). However, the impact of these differences on functional outcome has not been fully elucidated yet.…”

Section: Introductionmentioning

confidence: 99%

Connectivity Measures Differentiate Cortical and Subcortical Sub-Acute Ischemic Stroke Patients

Fanciullacci

Panarese

Spina

et al. 2021

Front. Hum. Neurosci.

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Brain lesions caused by cerebral ischemia lead to network disturbances in both hemispheres, causing a subsequent reorganization of functional connectivity both locally and remotely with respect to the injury. Quantitative electroencephalography (qEEG) methods have long been used for exploring brain electrical activity and functional connectivity modifications after stroke. However, results obtained so far are not univocal. Here, we used basic and advanced EEG methods to characterize how brain activity and functional connectivity change after stroke. Thirty-three unilateral post stroke patients in the sub-acute phase and ten neurologically intact age-matched right-handed subjects were enrolled. Patients were subdivided into two groups based on lesion location: cortico-subcortical (CS, n = 18) and subcortical (S, n = 15), respectively. Stroke patients were evaluated in the period ranging from 45 days since the acute event (T0) up to 3 months after stroke (T1) with both neurophysiological (resting state EEG) and clinical assessment (Barthel Index, BI) measures, while healthy subjects were evaluated once. Brain power at T0 was similar between the two groups of patients in all frequency bands considered (δ, θ, α, and β). However, evolution of θ-band power over time was different, with a normalization only in the CS group. Instead, average connectivity and specific network measures (Integration, Segregation, and Small-worldness) in the β-band at T0 were significantly different between the two groups. The connectivity and network measures at T0 also appear to have a predictive role in functional recovery (BI T1-T0), again group-dependent. The results obtained in this study showed that connectivity measures and correlations between EEG features and recovery depend on lesion location. These data, if confirmed in further studies, on the one hand could explain the heterogeneity of results so far observed in previous studies, on the other hand they could be used by researchers as biomarkers predicting spontaneous recovery, to select homogenous groups of patients for the inclusion in clinical trials.

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Neurophysiological Characterization of Subacute Stroke Patients: A Longitudinal Study

Cited by 13 publications

References 38 publications

Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement

Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement

Short-term Efficacy of Hand-Arm Bimanual Intensive Training on Upper Arm Function in Acute Stroke Patients: A Randomized Controlled Trial

Connectivity Measures Differentiate Cortical and Subcortical Sub-Acute Ischemic Stroke Patients

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