title: Cortical activity modulation by botulinum toxin type A in patients with post-stroke arm spasticity: real and imagined hand movement.
abstract: BACKGROUND
  Our aim was to use functional magnetic resonance imaging (fMRI) to compare brain activation changes due to botulinum toxin A (BoNT) application between two chronic stroke patient groups with different degree of weakness treated for upper limb spasticity.
  
  
  METHODS
  Fourteen ischemic stroke patients with hand weakness and spasticity were studied. Spasticity was scored by modified Ashworth scale (MAS). FMRI was performed 3 times: before (W0) and 4 (W4) and 11 weeks (W11) after BoNT application. Group A: 7 patients (2 males, 5 females; mean age 59.14 years) with hand plegia, who imagined moving fingers. Group B: 7 age-matched patients (6 males, 1 female; mean age 59.57 years) able to perform sequential finger movement.
  
  
  RESULTS
  BoNT transiently lowered MAS in W4 in both groups. In group A, activation of the frontal premotor cortex dominated and persisted for all three fMRI sessions whereas the ipsilesional cerebellum and cortex bordering bilateral intraparietal sulcus activation changed over time. Between-session contrasts showed treatment-related activation decreases in the mesial occipitoparietal and lateral occipital cortex. In group B, brain activation was markedly reduced after BoNT (W4). Whereas some of these areas manifested only transient reduction and expanded again at W11, in others the reduction persisted.
  
  
  CONCLUSIONS
  Study of two age-matched groups with mild and severe weakness demonstrated different effects of BoNT-lowered spasticity on sensorimotor networks. Group A performing movement imagery manifested BoNT-induced reduction of activation in structures associated with visual imagery. Group B performing movement manifested reduced activation extent and reduced activation of structures outside classical motor system, suggestive of motor network normalization.
authors.affiliation: Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic. Electronic address: veverka.tomas@seznam.cz.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Veverka
authors.affiliation: Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic; Department of Radiology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Hluštík
authors.affiliation: Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Hok
authors.affiliation: Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Otruba
authors.affiliation: Department of Radiology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Zbyněk
authors.initials: Z
authors.lastname: Tüdös
authors.affiliation: Department of Biophysics, Biometry and Statistics, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Zapletalová
authors.affiliation: Department of Physiotherapy, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Alois
authors.initials: A
authors.lastname: Krobot
authors.affiliation: Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kaňovský
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000494:pharmacology* / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D007092:Imagination / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000187:drug effects* / Q000502:physiology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D010243:Paralysis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Functional magnetic resonance imaging; Hand weakness; Neuronal plasticity; Spasticity; Stroke