title: Brain perfusion and upper limb motor function: a pilot study on the correlation between evolution of asymmetry in cerebral blood flow and improvement in Fugl-Meyer Assessment score after rTMS in chronic post-stroke patients.
abstract: OBJECTIVE
  Few studies have explored the refinement of asymmetry in regional cerebral blood flow in relation to behavioral improvement after treatment. The purpose of this retrospective pilot study was to identify cerebral cortical regions with improved perfusion that correlated with improvement of upper limb motor function after repetitive transcranial magnetic stimulation (rTMS).
  
  
  METHODS
  The study subjects were 33 post-stroke patients with upper limb hemiparesis who underwent rTMS combined with intensive occupational therapy (mean ± SD age: 64.9 ± 11.2 years; time since onset of stroke: 57.3 ± 45.9 months). Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT) were applied before and after treatment to evaluate motor function in the affected upper limb. Regional brain perfusion was measured by single-photon emission computed tomography, and the percentages of asymmetry values (asymmetry index [AI]) for 52 bilateral regions of interest were calculated. The change in AI was calculated as the post-intervention minus pre-intervention values.
  
  
  RESULTS
  Changes in AI in the superior and middle frontal areas correlated significantly and negatively with changes in FMA score (superior: r = -0.406, P = 0.03, R(2) = 0.251; middle: r = -0.437, P < 0.001, R(2) = 0.306), but not with changes in WMFT log performance time.
  
  
  CONCLUSIONS
  Changes in AI less than zero reflect improved perfusion, suggesting that upper limb motor function improvement in post-stroke patients reflects evolution of brain perfusion in the superior and middle frontal areas.
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, 105-8461 Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takekawa
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, 105-8461 Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
authors.affiliation: Department of Radiology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Mayuki
authors.initials: M
authors.lastname: Uchiyama
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, 105-8461 Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Ikegaya
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, 105-8461 Tokyo, Japan. Electronic address: abo@jikei.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
mesh_terms: D001783:Blood Flow Velocity; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D002908:Chronic Disease; D006801:Humans; D008875:Middle Aged; D009415:Nerve Net / Q000000981:diagnostic imaging / Q000503:physiopathology; D010291:Paresis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000517:prevention & control*; D010865:Pilot Projects; D011877:Radionuclide Imaging; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
keywords: Cerebrovascular circulation; Chronic brain damage; Single-photon emission computed tomography; Transcranial magnetic stimulation; Upper extremity