Abstract
To develop individualized motor rehabilitation, knowledge of the relationship between neuroplastic reorganization and motor recovery after pediatric arterial ischemic stroke (AIS) is crucial. Thus, we investigated functional connectivity in patients after AIS with good motor outcome and in patients with hemiparesis compared with typically developing peers. We included 18 patients (n = 9 with hemiparesis, n = 9 with good motor outcome) with pediatric AIS in the chronic phase (≥ 2 years after diagnosis, diagnosed > 16 years) and 18 peers matched by age and gender. Participants underwent a standardized motor assessment, single-pulse transcranial magnetic stimulation to determine the type of corticospinal tract wiring, and resting-state functional magnetic resonance imaging to examine motor network connectivity. Corticospinal tract wiring was contralateral in all participants. Patients with hemiparesis had lower interhemispheric connectivity strength compared with patients with good clinical outcome and peers. Patients with good clinical outcome had higher intrahemispheric connectivity strength compared with peers. Further, higher intrahemispheric connectivity was related to better motor outcome in patients. Our findings suggest that better motor outcome after pediatric AIS is related to higher motor network connectivity strength. Thus, resting-state functional connectivity might be predictive for motor recovery after pediatric AIS.
Highlights
To develop individualized motor rehabilitation, knowledge of the relationship between neuroplastic reorganization and motor recovery after pediatric arterial ischemic stroke (AIS) is crucial
These include (1) ipsilateral corticospinal pathways, (2) contralateral corticospinal pathways as expected in a typically developing brain, and (3) mixed corticospinal pathways, which can be assessed with single-pulse transcranial magnetic stimulation (TMS)[13]
The final study population consisted of 18 patients with AIS of whom nine were diagnosed with hemiparesis (PSOM > 0.5; mean age ± standard deviation [s.d.]: 15.49 ± 4.64 years), while nine had a good clinical outcome (PSOM = 0; mean age ± s.d.: 15.24 ± 4.10 years). 18 healthy subjects were matched regarding age and gender
Summary
To develop individualized motor rehabilitation, knowledge of the relationship between neuroplastic reorganization and motor recovery after pediatric arterial ischemic stroke (AIS) is crucial. We investigated functional connectivity in patients after AIS with good motor outcome and in patients with hemiparesis compared with typically developing peers. Unilateral brain injury can result in different patterns of corticospinal tract r eorganization[11,12] These include (1) ipsilateral corticospinal pathways (the representation of the paretic hand in the primary motor cortex is on the same side as the lesion), (2) contralateral corticospinal pathways (the representation of the paretic hand in the primary motor cortex is on the contralateral side to the lesion) as expected in a typically developing brain, and (3) mixed corticospinal pathways, which can be assessed with single-pulse transcranial magnetic stimulation (TMS)[13]. Previous studies suggest that patients with contralateral corticospinal tract wiring have more preserved motor function than those with mixed or ipsilateral corticospinal tract wiring[12,13,14,15,16] These different corticospinal tract reorganization patterns and lesion-related characteristics have often limited predictive value for post-stroke motor outcome. Mintzopoulos, et al.[30] investigated patients with good motor recovery after AIS and found increased intrahemispheric connectivity between the primary motor cortex and supplementary motor area, most likely an adaptive compensatory process
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