Multimodal imaging of brain reorganization in motor areas of the contralesional hemisphere of well recovered patients after capsular stroke

Gerloff, Christian; Bushara, Khalaf; Sailer, Alexandra; Wassermann, Eric M.; Chen, Robert; Matsuoka, Takahiro; Waldvogel, Daniel; Wittenberg, George F.; Ishii, Kenji; Cohen, Leonardo G.; Hallett, Mark

doi:10.1093/brain/awh713

Cited by 452Stroke Rehabilitation and RecoveryTranscranial Magnetic Stimulation StudiesMotor Control and Adaptation

Multimodal imaging of brain reorganization in motor areas of the contralesional hemisphere of well recovered patients after capsular stroke

Gerloff, Christian, Bushara, Khalaf, Sailer, Alexandra, Wassermann, Eric M., Chen, Robert, Matsuoka, Takahiro, Waldvogel, Daniel, Wittenberg, George F. +3 more·2006·Brain

DOI 10.1093/brain/awh713

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Abstract

Clinical recovery after stroke can be significant and has been attributed to plastic reorganization and recruitment of novel areas previously not engaged in a given task. As equivocal results have been reported in studies using single imaging or electrophysiological methods, here we applied an integrative multimodal approach to a group of well-recovered chronic stroke patients (n = 11; aged 50-81 years) with left capsular lesions. Focal activation during recovered hand movements was assessed with EEG spectral analysis and H2(15)O-PET with EMG monitoring, cortico-cortical connectivity with EEG coherence analysis (cortico-cortical coherence) and corticospinal connectivity with transcranial magnetic stimulation (TMS). As seen from comparisons with age-matched controls, our patients showed enhanced recruitment of the lateral premotor cortex of the lesioned hemisphere [Brodmann area (BA) 6], lateral premotor and to a lesser extent primary sensorimotor and parietal cortex of the contralesional hemisphere (CON-H; BA 4 and superior parietal lobule) and left cerebellum (patients versus controls, Z > 3.09). EEG coherence analysis showed that after stroke cortico-cortical connections were reduced in the stroke hemisphere but relatively increased in the CON-H (ANOVA, contrast analysis, P < 0.05), suggesting a shift of functional connectivity towards the CON-H. Nevertheless, fast conducting corticospinal transmission originated exclusively from the lesioned hemisphere. No direct ipsilateral motor evoked potentials (MEPs) could be elicited with TMS over the contralesional primary motor cortex (iM1) in stroke patients. We conclude that (i) effective recovery is based on enhanced utilization of ipsi- and contralesional resources, (ii) basic corticospinal commands arise from the lesioned hemisphere without recruitment of ('latent') uncrossed corticospinal tract fibres and (iii) increased contralesional activity probably facilitates control of recovered motor function by operating at a higher-order processing level, similar to but not identical with the extended network concerned with complex movements in healthy subjects.

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This evidence comes from indirect outcome measures, such as MRI and electroencephalography, which provide information about the macroscopic but not microscopic level.
“However, this evidence results from indirect outcome measures, such as MRI101 and electroencephalography,102 which provide infor mation about the macroscopic (ie, tissue), but not microscopic (ie, cellular or even subcellular) level.”
From Promoting brain remodelling and plasticity for stroke recovery: therapeutic promise and potential pitfalls of clinical translation (2012) · cites this paper as [102]
Solid evidence exists for a contribution of pyramidal tract remodelling to functional recovery in stroke patients.
“Solid evidence exists for a contribution of pyramidal tract remodelling to functional recovery in stroke patients.101,102”
From Promoting brain remodelling and plasticity for stroke recovery: therapeutic promise and potential pitfalls of clinical translation (2012) · cites this paper as [102]

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Authors: Gerloff, C., Bushara, K., Sailer, A., Wassermann, E. M., Chen, R., Matsuoka, T., Waldvogel, D., Wittenberg, G. F., Ishii, K., Cohen, L. G., & Hallett, M.
Affiliations: University of Tübingen (DE)
National Institutes of Health (US)
Corresponding author: Gerloff, Christian
ORCID: Gerloff, Christian
Wassermann, Eric M.
Chen, Robert
Matsuoka, Takahiro
Waldvogel, Daniel
Wittenberg, George F.
Ishii, Kenji
Cohen, Leonardo G.
Hallett, Mark
Venue: Brain
Publisher: Oxford University Press (OUP)
Published: 2005-12-19
Volume: 129
Issue: 3
Pages: 791-808
ISSN: 0006-8950 (ISSN-L)
1460-2156
DOI: 10.1093/brain/awh713
OpenAlex: W2100254792
Cited by: 452
References: 130
Citations by year: 2026: 7 · 2025: 10 · 2024: 13 · 2023: 22 · 2022: 24 · 2021: 16 · 2020: 20 · 2019: 20 · 2018: 21 · 2017: 30 · 2016: 22 · 2015: 20 · 2014: 27 · 2013: 31 · 2012: 36
FWCI: 20.89
Type: journal article
Language: en
Open access: closed
Locations: Brain (publishedVersion)
PubMed (publishedVersion)
Funders: Deutsche Forschungsgemeinschaft (SFB 307, SFB 550)
National Institutes of Health
Topics: Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
Keywords: stroke recovery, brain reorganization, contralesional hemisphere, lateral premotor cortex, corticocortical connections, motor evoked potentials, cerebellum, EEG coherence, transcranial magnetic stimulation, hand movement, chronic stroke
MeSH terms: Stroke Rehabilitation, Aged, Aged, 80 and over, Brain Mapping, Cerebrovascular Circulation, Chronic Disease, Electroencephalography, Female, Hand, Humans, Male, Middle Aged, Motor Cortex, Movement, Neuronal Plasticity, Evoked Potentials, Motor, Stroke, Positron-Emission Tomography, Transcranial Magnetic Stimulation

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Multimodal imaging of brain reorganization in motor areas of the contralesional hemisphere of well recovered patients after capsular stroke

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