title: Dynamics of language reorganization after stroke.
abstract: Previous functional imaging studies of chronic stroke patients with aphasia suggest that recovery of language occurs in a pre-existing, bilateral network with an upregulation of undamaged areas and a recruitment of perilesional tissue and homologue right language areas. The present study aimed at identifying the dynamics of reorganization in the language system by repeated functional MRI (fMRI) examinations with parallel language testing from the acute to the chronic stage. We examined 14 patients with aphasia due to an infarction of the left middle cerebral artery territory and an age-matched control group with an auditory comprehension task in an event-related design. Control subjects were scanned once, whereas patients were scanned repeatedly at three consecutive dates. All patients recovered clinically as shown by a set of aphasia tests. In the acute phase [mean: 1.8 days post-stroke (dps)], patients' group analysis showed little early activation of non-infarcted left-hemispheric language structures, while in the subacute phase (mean: 12.1 dps) a large increase of activation in the bilateral language network with peak activation in the right Broca-homologue (BHo) was observed. A direct comparison of both examinations revealed the strongest increase of activation in the right BHo and supplementary motor area (SMA). These upregulated areas also showed the strongest correlation between improved language function and increased activation (r(BHo) = 0.88, r(SMA) = 0.92). In the chronic phase (mean: 321 dps), a normalization of activation with a re-shift of peak activation to left-hemispheric language areas was observed, associated with further language improvement. The data suggest that brain reorganization during language recovery proceeds in three phases: a strongly reduced activation of remaining left language areas in the acute phase is followed by an upregulation with recruitment of homologue language zones, which correlates with language improvement. Thereafter, a normalization of activation is observed, possibly reflecting consolidation in the language system.
authors.affiliation: Department of Neurology, University Freiburg, Breisacher Strasse 64, 79106 Freiburg, Germany. dorothee.saur@uniklinik-freiburg.de
authors.forename: Dorothee
authors.initials: D
authors.lastname: Saur
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Annette
authors.initials: A
authors.lastname: Baumgaertner
authors.forename: Valeska
authors.initials: V
authors.lastname: Schraknepper
authors.forename: Klaus
authors.initials: K
authors.lastname: Willmes
authors.forename: Michel
authors.initials: M
authors.lastname: Rijntjes
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity; D020127:Recovery of Function