Abstract
Several biomarkers have been identified which enable a considerable prediction of hand-motor outcome after cerebral damage already in the subacute stage after stroke. We here review the value of MRI biomarkers in the evaluation of corticospinal integrity and functional recruitment of motor resources. Many of the functional imaging parameters are not feasible early after stroke or for patients with high impairment and low compliance. Whereas functional connectivity parameters have demonstrated varying results on their predictive value for hand-motor outcome, corticospinal integrity evaluation using structural imaging showed robust and high predictive power for patients with different levels of impairment. Although this is indicative of an overall higher value of structural imaging for prediction, we suggest that this variation be explained by structure and function relationships. To gain more insight into the recovering brain, not only one biomarker is needed. We rather argue for a combination of different measures in an algorithm to classify fine-graded subgroups of patients. Approaches to determining biomarkers have to take into account the established markers to provide further information on certain subgroups. Assessing the best therapy approaches for individual patients will become more feasible as these subgroups become specified in more detail. This procedure will help to considerably save resources and optimize neurorehabilitative therapy.
Highlights
Several biomarkers have been identified which enable a considerable prediction of hand-motor outcome after cerebral damage already in the subacute stage after stroke
Whereas functional connectivity parameters have demonstrated varying results on their predictive value for hand-motor outcome, corticospinal integrity evaluation using structural imaging showed robust and high predictive power for patients with different levels of impairment. This is indicative of an overall higher value of structural imaging for prediction, we suggest that this variation be explained by structure and function relationships
The composed recovery score does not reveal which component leads to the measured improvement, and the principal component analyses (PCA) scores are dependent on the specific data set, which varies with different studies
Summary
Stroke continues to be the leading cause for long-term disabilities. Worldwide, about 5 million people who have suffered from a stroke remain permanently impaired [1], leaving a majority of patients with disturbances in the motor abilities [2]. The time after stroke is a relevant factor for plasticity: the acute and subacute phases after stroke are characterized by augmented plasticity, which can last up to 3 or 4 months [7]. In these early stages, therapeutic intervention may lead to functionally relevant improvements whereas, in the chronic stage, the potential to recover basic functions is limited (e.g., [8, 9]). Imaging techniques can complement the clinical assessment and provide an insight into the patient’s individual plasticity processes and offer appropriate therapy. The diagram was modified after [11]
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