Predictors and signatures of recovery from neglect in acute stroke

Umarova, Roza; Nitschke, Kai; Kaller, Christoph P.; Klöppel, Stefan; Beume, Lena-Alexandra; Mader, Irina; Martin, Markus; Hennig, Jürgen; Weiller, Cornelius

doi:10.1002/ana.24614

Cited by 63 publications

(43 citation statements)

References 76 publications

(194 reference statements)

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“…However, the effects of this stimulation present with a considerable interindividual variability (Lefaucheur et al, 2014), which is scarcely understood. According to recent findings (Umarova et al, 2016), the role of the contralesional hemisphere in neglect could be compensatory, rendering its inhibitory stimulation even detrimental. Moreover, recent accounts postulate that the recovery of stroke in general, and of neglect in particular, would follow !…”

Section: Discussionmentioning

confidence: 97%

“…However, on an individual level, a conspicuous variability in the effects of contralesional, inhibitory NIBS in neglect has been observed, i.e., not all patients equally benefit from this approach (Lefaucheur et al, 2014). Conversely, and somewhat in line with this variability, some studies point to a compensatory role of the contralesional, undamaged hemisphere (Lunven et al, 2015;Umarova et al, 2016), suggesting that its activity should be facilitated rather than inhibited. Finally, in a third perspective, other recent studies have suggested that neglect recovery dynamics after stroke follow fixed, non-influenceable patterns: within three months after stroke, patients would recover ≈70% of their initial impairment, irrespectively of the type of applied therapeutic approaches (i.e., the so-called Proportional recovery rule, (Marchi et al, 2017;Ramsey et al, 2017;Winters et al, 2017)).…”

Section: Introductionmentioning

confidence: 99%

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Theta burst stimulation in neglect after stroke: functional outcome and response variability origins

Nyffeler

Vanbellingen

Kaufmann

et al. 2019

Brain

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Spatial neglect is a strong and negative predictor of general functional outcome after stroke, and its therapy remains a challenge. Whereas inhibitory non-invasive brain stimulation (NIBS) over the contralesional, intact hemisphere has generally been shown to ameliorate neglect on a group level, a conspicuous variability of the effects at the individual level is typically observed. We aimed to comprehensively assess the characteristics and determinants of the effects of inhibitory NIBS in neglect, identifying which patients would respond to this therapeutic approach and which not. To this end, we prospectively included sixty patients with a subacute right-hemispheric stroke. In thirty patients with spatial neglect, continuous Theta Burst Stimulation (cTBS) was applied over the left posterior parietal cortex (PPC) in a randomized clinical trial, either in 8 or 16 trains, or as sham stimulation. Thirty patients without neglect served as control group. Neglect severity was measured with a neuropsychological test battery and the Catherine Bergego Scale (CBS), at admission to and at discharge from inpatient neurorehabilitation, as well as at 3 months follow-up. General functional outcome was assessed by means of the Functional Independent Measurement (FIM) and the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS). The impact of clinical and demographic factors was evaluated, and the influence of lesion location and extension was assessed by means of voxel-based lesionsymptom mapping (VLSM). On a group level, both cTBS protocols (i.e., 8 and 16 trains) significantly reduced neglect severity in both the CBS and the neuropsychological tests, at discharge and 3 months later. Furthermore, cTBS significantly improved general functional outcome. On an individual level, hierarchical cluster and VLSM analyses revealed that the variability in the responses to cTBS is determined by the integrity of inter-hemispheric connections within the corpus callosum, in particular parieto-parietal connections. In cTBS responders, in whom neglect and general functional outcome were significantly improved, the corpus callosum was intact, whereas this was not the case in cTBS non-responders. Moreover, analyses based on the Proportional recovery rule and the Maugeri predictive stroke recovery model showed that the recovery ! ! 3! ! of neglect and of the activities of daily living (ADL) was accelerated only in cTBS responders. Furthermore, the level of ADL recovery of these neglect patients was brought close to the one of right-hemispheric control patients without neglect. Hence, in neglect patients with intact interhemispheric connectivity, cTBS over the contralesional PPC significantly improves and accelerates neglect recovery and, associated with it, general functional outcome.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Theta burst stimulation in neglect after stroke: functional outcome and response variability origins

Nyffeler

Vanbellingen

Kaufmann

et al. 2019

Brain

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“…Apart from perfusion, there is important clinical implications for the estimation of the function of the brain in the poststroke phase. rs‐fMRI is an imaging technique that can estimate brain function noninvasively and has been used increasingly more for functional recovery assessment in stroke patients . In this study we applied three rs‐fMRI measurements: FC, ALFF, and ReHo, to assess the functional recovery of AIS patients after reperfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

“…rs-fMRI is an imaging technique that can estimate brain function noninvasively and has been used increasingly more for functional recovery assessment in stroke patients. [24][25][26] In this study we applied three rs-fMRI measurements: FC, ALFF, and ReHo, to assess the functional recovery of AIS patients after reperfusion therapy. To the best of our knowledge, a voxelwise analysis of the functional status of the brain using rs-fMRI has not been conducted in AIS patients after reperfusion treatment.…”

Section: Discussionmentioning

confidence: 99%

One‐step analysis of brain perfusion and function for acute stroke patients after reperfusion: A resting‐state fMRI study

Chen

Zhou

Zhang

et al. 2018

Magnetic Resonance Imaging

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Background Resting‐state functional magnetic resonance imaging (rs‐fMRI) can noninvasively estimate the perfusion and function of the brain. Purpose To investigate the perfusion and functional status using rs‐fMRI in acute ischemic stroke (AIS) patients after reperfusion therapy. Study Type Prospective. Subjects Twenty‐five AIS patients who underwent dynamic susceptibility contrast (DSC) upon hospital admission and both rs‐fMRI and DSC scans at 24 hours after reperfusion therapy. Field Strength/Sequence 3T; DSC, rs‐fMRI. Assessment The time delay of the blood oxygenation level‐dependent (BOLD) signal was calculated using time‐shift‐analysis (TSA) and compared with the time to peak (TTP) derived from the DSC. For patients who exhibited partial or complete reperfusion in the supratentorial hemisphere, we quantified the function of different regions (healthy tissue, reperfused tissue, not reperfused tissue) by using three rs‐fMRI measurements (functional connectivity, the amplitude of low‐frequency fluctuation [ALFF] and regional homogeneity [ReHo]). Correlations between the functional measurements and modified Rankin Scale (mRS) scores were calculated. Statistical Tests Dice coefficient (DC) analysis, two‐sample t‐tests, Pearson correlation coefficient. Results Twelve patients who exhibited complete reperfusion on their TTP maps showed no time‐delayed areas on the TSA maps. For the remaining 13 patients with partial reperfusion (5/13) or no reperfusion (8/13) on the TTP maps, the TSA detected comparable time‐delayed areas. Eleven out of 13 patients showed moderate to good overlap (mean DC, 0.58 ± 0.1) between the TTP and TSA results. Fourteen patients were chosen for functional analyses and most patients (12/14) showed abnormal functional connectivity in the reperfused regions. The reperfused and not reperfused tissues had lower mean ReHo values than those of the healthy tissue (both P < 0.001). The mRS scores showed negative correlation with mean ReHo values of reperfused region (R = –0.523, P = 0.027). Data Conclusion rs‐fMRI might be a useful way to estimate both the perfusion and functional status for AIS patients after reperfusion therapy. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:221–229.

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“…A longitudinal fMRI study revealed different signatures: a favorable course of recovery was specifically associated with increased activation in essential functional nodes, when the left prefrontal region replaces the irreversibly damaged ventral attention system and supports spatial performance, driving the preserved ipsilesional dorsal attention system. The strength of functional connectivity between right parietal and left prefrontal region might predict the course of recovery [119. ]…”

Section: Structural Imagingmentioning

confidence: 99%

Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke

Heiss¹

2017

Cerebrovasc Dis

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Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.

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Predictors and signatures of recovery from neglect in acute stroke

Cited by 63 publications

References 76 publications

Theta burst stimulation in neglect after stroke: functional outcome and response variability origins

Theta burst stimulation in neglect after stroke: functional outcome and response variability origins

One‐step analysis of brain perfusion and function for acute stroke patients after reperfusion: A resting‐state fMRI study

Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke

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