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Brain regions important for recovery after severe post-stroke upper limb paresis

Title
Brain regions important for recovery after severe post-stroke upper limb paresis
Authors
Rondina J.M.Park C.-H.Ward N.S.
Ewha Authors
박창현
SCOPUS Author ID
박창현scopus
Issue Date
2017
Journal Title
Journal of Neurology, Neurosurgery and Psychiatry
ISSN
0022-3050JCR Link
Citation
vol. 88, no. 9, pp. 737 - 743
Keywords
corticospinal tractlesion likelihoodmotor recoveryproportional recoverystrokesupport vector machine.
Publisher
BMJ Publishing Group
Indexed
SCI; SCIE; SCOPUS WOS scopus
Abstract
Background The ability to predict outcome after stroke is clinically important for planning treatment and for stratification in restorative clinical trials. In relation to the upper limbs, the main predictor of outcome is initial severity, with patients who present with mild to moderate impairment regaining about 70% of their initial impairment by 3 months post-stroke. However, in those with severe presentations, this proportional recovery applies in only about half, with the other half experiencing poor recovery. The reasons for this failure to recover are not established although the extent of corticospinal tract damage is suggested to be a contributory factor. In this study, we investigated 30 patients with chronic stroke who had presented with severe upper limb impairment and asked whether it was possible to differentiate those with a subsequent good or poor recovery of the upper limb based solely on a T1-weighted structural brain scan. Methods A support vector machine approach using voxel-wise lesion likelihood values was used to show that it was possible to classify patients as good or poor recoverers with variable accuracy depending on which brain regions were used to perform the classification. Results While considering damage within a corticospinal tract mask resulted in 73% classification accuracy, using other (non-corticospinal tract) motor areas provided 87% accuracy, and combining both resulted in 90% accuracy. Conclusion This proof of concept approach highlights the relative importance of different anatomical structures in supporting post-stroke upper limb motor recovery and points towards methodologies that might be used to stratify patients in future restorative clinical trials. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.
DOI
10.1136/jnnp-2016-315030
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연구기관 > 의과학연구소 > Journal papers
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