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Brain Advance Access originally published online on January 18, 2006
Brain 2006 129(3):809-819; doi:10.1093/brain/awl002
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© The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Motor system activation after subcortical stroke depends on corticospinal system integrity

Nick S. Ward1,2, Jennifer M. Newton1, Orlando B. C. Swayne3, Lucy Lee1, Alan J. Thompson2, Richard J. Greenwood2, John C. Rothwell3 and Richard S. J. Frackowiak1,4,5

1 Wellcome Department of Imaging Neuroscience, 2 Department of Headache, Brain Injury and Rehabilitation, 3 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK, 4 IRCCS Santa Lucia, Rome, Italy and 5 Département d'études cognitives, Ecole Normale Superieure, Paris, France

Correspondence to: Dr N. S. Ward, Wellcome Department of Imaging Neuroscience, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK E-mail: n.ward{at}fil.ion.ucl.ac.uk

Movement-related brain activation patterns after subcortical stroke are characterized by relative overactivations in cortical motor areas compared with controls. In patients able to perform a motor task, overactivations are greater in those with more motor impairment. We hypothesized that recruitment of motor regions would shift from primary to secondary motor networks in response to impaired functional integrity of the corticospinal system (CSS). We measured the magnitude of brain activation using functional MRI during a motor task in eight chronic subcortical stroke patients. CSS functional integrity was assessed using transcranial magnetic stimulation to obtain stimulus/response curves for the affected first dorsal interosseus muscle, with a shallower gradient representing increasing disruption of CSS functional integrity. A negative correlation between the gradient of stimulus/response curve and magnitude of task-related brain activation was found in several motor-related regions, including ipsilesional posterior primary motor cortex [Brodmann area (BA) 4p], contralesional anterior primary motor cortex (BA 4a), bilateral premotor cortex, supplementary motor area, intraparietal sulcus, dorsolateral prefrontal cortex and contralesional superior cingulate sulcus. There were no significant positive correlations in any brain region. These results suggest that impaired functional integrity of the CSS is associated with recruitment of secondary motor networks in both hemispheres in an attempt to generate motor output to spinal cord motoneurons. Secondary motor regions are less efficient at generating motor output so this reorganization can only be considered partially successful in reducing motor impairment after stroke.

Key Words: functional brain imaging; motor recovery; motor system; stroke

Abbreviations: BA = Brodmann area; CSS = corticospinal system; FDI = first dorsal interosseus; fMRI = functional MRI; MEP = motor evoked potential; NHPT = nine hole peg test; rMT = resting motor threshold; SMA = supplementary motor area; SPM = Statistical Parametric Mapping; TMS = transcranial magnetic stimulation; VAS = visual analogue scale

Received September 2, 2005. Revised November 30, 2005. Accepted December 5, 2005.


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