title: The relationship between motor deficit and hemisphere activation balance after stroke: A 3T fMRI study.
abstract: Functional imaging during movement of the hand affected by a stroke has shown excess activation of the contralesional motor network, implying less physiological hemisphere activation balance. Although this may be adaptive, the relationship between the severity of motor deficit and the hemisphere activation balance for the four major cortical motor areas has not been systematically studied. We prospectively studied 19 right-handed patients with first-ever stroke (age range 61+/-10 years) in the stable phase of recovery (>3 months after onset), using auditory-paced index-thumb (IT) tapping of the affected hand at 1.25 Hz as the fMRI paradigm. The hemisphere activation balance for the primary motor (M1), primary somatosensory (S1), supplementary motor (SMA) and dorsal premotor (PMd) areas was measured by a modified weighted laterality index (wLI), and correlations with motor performance (assessed by the affected/unaffected ratio of maximum IT taps in 15 s, termed IT-R) were computed. There were statistically significant negative correlations between IT-R and the wLI for M1 and S1, such that the more the hemispheric balance shifted contralesionally, the worse the performance. Furthermore, worse performance was related to a greater amount of contralesional, but not ipsilesional, activation. No significant correlation between IT-R and the wLI was obtained for the SMA and PMd, which functionally have stronger bilateral organization. These findings suggest that the degree of recovery of fine finger motion after stroke is determined by the extent to which activation balance in the primary sensory motor areas--where most corticospinal fibers originate--departs from normality. This observation may have implications for therapy.
authors.affiliation: University of Cambridge, Department of Clinical Neurosciences, Addenbrooke's Hospital Box 83 Cambridge CB2 2QQ, UK.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Calautti
authors.forename: Marcello
authors.initials: M
authors.lastname: Naccarato
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jones
authors.forename: Nikhil
authors.initials: N
authors.lastname: Sharma
authors.forename: Diana D
authors.initials: DD
authors.lastname: Day
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Carpenter
authors.forename: Edward T
authors.initials: ET
authors.lastname: Bullmore
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Warburton
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D011446:Prospective Studies; D020521:Stroke / Q000503:physiopathology*