title: Initial motor impairment influences activation pattern of motor recovery.
abstract: OBJECTIVE
  We investigated the functional magnetic resonance imaging (fMRI) activation pattern of a motor task in patients with acute subcortical lesions to examine the relationship between activation pattern and recovery of motor impairment.
  
  
  METHODS
  Five patients (one with subcortical infarction and four with thalamic hemorrhage) were examined using fMRI 1 month after the insult. Impairment was assessed by the Medical Research Council motor strength classification (MRC). One patient with severe motor deficits was also studied at 4 months when her motor deficits improved up to MRC grade 4.
  
  
  RESULTS
  Three patients with relatively mild deficits (MRC grade 3 or 4) at their onsets, improved fully up to grade 5 within 1 month. FMRI performed at 1 month showed activation in the contralateral primary motor cortex and supplementary motor area (SMA), but no significant activation was seen on the ipsilateral unaffected side. Two patients with severe motor impairment (MRC grade 1) improved up to 3 and 4 of MRC at 1 month or later. They showed activation of the ipsilateral premotor area as well as contralateral primary motor cortex and SMA. One of them, whose severe motor deficit improved at 4 month, also showed activation of the ipsilateral postcentral gyrus and the activated area expanded longitudinally corresponding with her functional recovery.
  
  
  CONCLUSIONS
  Our study demonstrates that the fMRI pattern varies according to functional recovery, suggesting the importance of the ipsilateral premotor area and postcentral gyrus especially for those patients with severe motor impairment initially.
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan. mkobayas@sc.itc.keio.ac.jp
authors.forename: Masahito
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Hideichi
authors.initials: H
authors.lastname: Takayama
authors.forename: Ban
authors.initials: B
authors.lastname: Mihara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawase
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ohira
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000503:physiopathology*; D001931:Brain Mapping; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009044:Motor Cortex / Q000098:blood supply / Q000473:pathology; D009048:Motor Skills / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D012720:Severity of Illness Index