title: Brain plasticity after implanted peroneal nerve electrical stimulation to improve gait in chronic stroke patients: Two case reports.
abstract: BACKGROUND
  Recent studies have shown that stimulation of the peroneal nerve using an implantable 4-channel peroneal nerve stimulator could improve gait in stroke patients.
  
  
  OBJECTIVE
  To assess structural cortical and regional cerebral metabolism changes associated with an implanted peroneal nerve electrical stimulator to correct foot drop related to a central nervous system lesion.
  
  
  METHODS
  Two stroke patients presenting a foot drop related to a central nervous system lesion were implanted with an implanted peroneal nerve electrical stimulator. Both patients underwent clinical evaluations before implantation and one year after the activation of the stimulator. Structural magnetic resonance imaging (MRI) and [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) were acquired before and one year after the activation of the stimulator.
  
  
  RESULTS
  Foot drop was corrected for both patients after the implantation of the stimulator. After one year of treatment, patient 1 improved in three major clinical tests, while patient 2 only improved in one test. Prior to treatment, FDG-PET showed a significant hypometabolism in premotor, primary and supplementary motor areas in both patients as compared to controls, with patient 2 presenting more widespread hypometabolism. One year after the activation of the stimulator, both patients showed significantly less hypometabolism in the damaged motor cortex. No difference was observed on the structural MRI.
  
  
  CONCLUSIONS
  Clinical improvement of gait under peroneal nerve electrical stimulation in chronic stroke patients presenting foot drop was paralleled to metabolic changes in the damaged motor cortex.
authors.affiliation: Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.|Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Aurore
authors.initials: A
authors.lastname: Thibaut
authors.affiliation: CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg.
authors.forename: Florent
authors.initials: F
authors.lastname: Moissenet
authors.affiliation: Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.
authors.forename: Carol
authors.initials: C
authors.lastname: Di Perri
authors.affiliation: CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg.
authors.forename: Céline
authors.initials: C
authors.lastname: Schreiber
authors.affiliation: CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg.
authors.forename: Angélique
authors.initials: A
authors.lastname: Remacle
authors.affiliation: CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kolanowski
authors.affiliation: CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Chantraine
authors.affiliation: Department of Nuclear Medicine, University Hospital of Liege, Liege, Belgium.
authors.forename: Claire
authors.initials: C
authors.lastname: Bernard
authors.affiliation: Department of Nuclear Medicine, University Hospital of Liege, Liege, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Hustinx
authors.affiliation: Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.|Department of Neuroimagery, University Hospital of Liege, Liege, Belgium.
authors.forename: Jean-Flory
authors.initials: JF
authors.lastname: Tshibanda
authors.affiliation: CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg.
authors.forename: Paul
authors.initials: P
authors.lastname: Filipetti
authors.affiliation: Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.affiliation: Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.|Department of Psychiatry, University of Wisconsin, Madison, WI, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Gosseries
mesh_terms: D000293:Adolescent; D001921:Brain / Q000502:physiology*; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity / Q000502:physiology*; D010543:Peroneal Nerve / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000628:therapy*
keywords: ActiGait; Functional electrical stimulation; brain plasticity; gait; motor deficit; positron emission tomography; stroke