ABSTRACT
OBJECTIVES: In this longitudinal pilot study, we investigated how manual dexterity recovery was related to corticospinal tract (CST) injury and excitability, in six patients undergoing conventional rehabilitation. METHODS: Key components of manual dexterity, namely finger force control, finger tapping rate and independence of finger movements, were quantified. Structural MRI was obtained to calculate CST lesion load. CST excitability was assessed by measuring rest motor threshold (RMT) and the amplitude of motor evoked potentials (MEPs) using transcranial magnetic stimulation (TMS). Measurements were obtained at two weeks, three and six months post-stroke. RESULTS: At six months post-stroke, complete recovery of hand gross motor impairment (i.e., maximal Fugl-Meyer score for hand) had occurred in three patients and four patients had recovered ability to accurately control finger force. However, tapping rate and independence of finger movements remained impaired in all six patients at six months. Recovery in hand gross motor impairment and finger force control occurred in patients with smaller CST lesion load and almost complete recovery of CST excitability, although RMT or MEP size remained slightly altered in the stroke-affected hemisphere compared to the unaffected hemisphere. The two patients with poorest recovery showed persistent absence of MEPs and greatest structural injury to CST. DISCUSSION: The findings support good motor recovery being overall correlated with smaller CST lesion, and with almost complete recovery of CST excitability. However, impairment of manual dexterity persisted despite recovery in gross hand movements and grasping abilities, suggesting involvement of additional brain structures for fine manual tasks.
Subject(s)
Motor Skills , Pyramidal Tracts/pathology , Pyramidal Tracts/physiopathology , Recovery of Function , Stroke Rehabilitation , Stroke/pathology , Stroke/physiopathology , Aged , Evoked Potentials, Motor , Female , Fingers , Humans , Longitudinal Studies , Male , Middle Aged , Pilot Projects , Prospective Studies , Pyramidal Tracts/injuries , Transcranial Magnetic Stimulation , Treatment OutcomeABSTRACT
White matter lesions (WMLs) are commonly observed in stroke patients with small vessel disease (SVD) and are thought to result from a progressive, irreversible disease process following arteriolosclerosis. In this study, we report a case of partial disappearance of WMLs 1 year after a lacunar stroke in a 69-year-old man with evidence of SVD. We also discuss possible mechanisms associated with this observation.
