title: Predictors and signatures of recovery from neglect in acute stroke.
abstract: OBJECTIVE
  Spatial neglect can either spontaneously resolve or persist after stroke; the latter is associated with a poorer outcome. We aimed to investigate the neural correlates and predictors of favorable versus poor recovery from neglect in acute stroke.
  
  
  METHODS
  In addition to neuropsychological testing, we explored task-related functional magnetic resonance imaging activation and functional connectivity in 34 patients with neglect and/or extinction. Patients were examined at 2 to 3 days (acute phase I) and 8 to 10 days (acute phase II), and some of them at 4 to 6 months (chronic phase) poststroke.
  
  
  RESULTS
  Course of recovery was predicted by the strength of functional connectivity between the right parietal and left prefrontal and parietal regions, as early as acute phase I. During acute phase II, favorable recovery from neglect was associated with increased activation in the left prefrontal and right parietal regions, an effect not observed at any time point in patients with poor acute recovery. The extent of neglect amelioration correlated with activation gain in the right attention centers; stronger activation of their left functional homologues correlated with better spatial processing in the neglected hemispace during both of the acute examination phases.
  
  
  CONCLUSIONS
  System excitability and early recruitment of contralesional functional homologues represented specific features of favorable recovery in acute stroke. In severe strokes leading to neglect, contralesional functional homologues support recovery by modulating the preserved ipsilesional network, and initial functional connectivity between them might predict recovery course and help to identify patients with potentially poor recovery requiring more intensive early rehabilitation.
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
authors.forename: Roza M
authors.initials: RM
authors.lastname: Umarova
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Nitschke
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Kaller
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.|Department of Psychiatry, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Klöppel
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Beume
authors.affiliation: Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Irina
authors.initials: I
authors.lastname: Mader
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Martin
authors.affiliation: Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.|Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hennig
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.|Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
mesh_terms: D000368:Aged; D002540:Cerebral Cortex / Q000503:physiopathology*; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D010468:Perceptual Disorders / Q000209:etiology / Q000503:physiopathology*; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000503:physiopathology*