Motor plasticity after extra-intracranial bypass surgery in occlusive cerebrovascular disease
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Motor plasticity after extra-intracranial bypass surgery in occlusive cerebrovascular disease. / Jussen, Daniel; Zdunczyk, Anna; Schmidt, Sein; Rösler, Judith; Buchert, Ralph; Julkunen, Petro; Karhu, Jari; Brandt, Stephan; Picht, Thomas; Vajkoczy, Peter.
in: NEUROLOGY, Jahrgang 87, Nr. 1, 05.07.2016, S. 27-35.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Motor plasticity after extra-intracranial bypass surgery in occlusive cerebrovascular disease
AU - Jussen, Daniel
AU - Zdunczyk, Anna
AU - Schmidt, Sein
AU - Rösler, Judith
AU - Buchert, Ralph
AU - Julkunen, Petro
AU - Karhu, Jari
AU - Brandt, Stephan
AU - Picht, Thomas
AU - Vajkoczy, Peter
N1 - © 2016 American Academy of Neurology.
PY - 2016/7/5
Y1 - 2016/7/5
N2 - OBJECTIVE: To explore plasticity in patients scheduled for extra-intracranial bypass surgery due to unilateral symptomatic occlusive cerebrovascular disease via navigated transcranial magnetic stimulation.METHODS: In this observational study, patients were allocated to different substudies and examined before and 3 months after operation. (1) Corticospinal excitability was determined via identification of the resting motor threshold. (2) Intracortical inhibition and facilitation were tested by paired pulse transcranial magnetic stimulation. (3) Area of cortical representation of the first dorsal interosseous muscle was identified.RESULTS: (1) Resting motor thresholds were higher in the affected hemispheres with impaired cerebrovascular reserve capacity compared to the unaffected hemispheres (45.7% ± 2.2% compared to 39.2% ± 1.4%, n = 39, p < 0.05). Reduced excitability normalized 3 months after revascularization (51% ± 2.6% → 45% ± 1.9%, n = 21, p < 0.05). (2) In paired pulse paradigms, there was a motor disinhibition in the operated hemispheres. (3) There was a reduction of the cortical representation areas of the first dorsal interosseous muscle (2.3 ± 0.5 cm(2) → 0.9 ± 0.6 cm(2), n = 9, p < 0.05) after operation.CONCLUSIONS: Our data demonstrate a reversibly impaired motor cortical function in the chronically ischemic brain. In carefully selected patients, cerebral revascularization leads to improved motor output indicated by a lower resting motor threshold, intracortical disinhibition, and more focused motor cortical representation.
AB - OBJECTIVE: To explore plasticity in patients scheduled for extra-intracranial bypass surgery due to unilateral symptomatic occlusive cerebrovascular disease via navigated transcranial magnetic stimulation.METHODS: In this observational study, patients were allocated to different substudies and examined before and 3 months after operation. (1) Corticospinal excitability was determined via identification of the resting motor threshold. (2) Intracortical inhibition and facilitation were tested by paired pulse transcranial magnetic stimulation. (3) Area of cortical representation of the first dorsal interosseous muscle was identified.RESULTS: (1) Resting motor thresholds were higher in the affected hemispheres with impaired cerebrovascular reserve capacity compared to the unaffected hemispheres (45.7% ± 2.2% compared to 39.2% ± 1.4%, n = 39, p < 0.05). Reduced excitability normalized 3 months after revascularization (51% ± 2.6% → 45% ± 1.9%, n = 21, p < 0.05). (2) In paired pulse paradigms, there was a motor disinhibition in the operated hemispheres. (3) There was a reduction of the cortical representation areas of the first dorsal interosseous muscle (2.3 ± 0.5 cm(2) → 0.9 ± 0.6 cm(2), n = 9, p < 0.05) after operation.CONCLUSIONS: Our data demonstrate a reversibly impaired motor cortical function in the chronically ischemic brain. In carefully selected patients, cerebral revascularization leads to improved motor output indicated by a lower resting motor threshold, intracortical disinhibition, and more focused motor cortical representation.
KW - Brain/diagnostic imaging
KW - Cerebral Revascularization
KW - Cerebrovascular Disorders/diagnostic imaging
KW - Evoked Potentials, Motor/physiology
KW - Female
KW - Follow-Up Studies
KW - Functional Laterality/physiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Motor Activity/immunology
KW - Muscle, Skeletal/physiopathology
KW - Neural Inhibition/physiology
KW - Neuronal Plasticity/physiology
KW - Pyramidal Tracts/diagnostic imaging
KW - Transcranial Magnetic Stimulation
KW - Treatment Outcome
U2 - 10.1212/WNL.0000000000002802
DO - 10.1212/WNL.0000000000002802
M3 - SCORING: Journal article
C2 - 27281529
VL - 87
SP - 27
EP - 35
JO - NEUROLOGY
JF - NEUROLOGY
SN - 0028-3878
IS - 1
ER -
