Early functional MRI activation predicts motor outcome after ischemic stroke: a longitudinal, multimodal study
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An accurate prediction of long term outcome after stroke is urgently required to provide early individualized neurorehabilitation. This study aimed to examine the added value of early neuroimaging measures and identify the best approaches for predicting motor outcome after stroke. This prospective study involved 34 first-ever ischemic stroke patients (time since stroke: 1–14 days) with upper limb impairment. All patients underwent baseline multimodal assessments that included clinical (age, motor impairment), neurophysiological (motor-evoked potentials, MEP) and neuroimaging (diffusion tensor imaging and motor task-based fMRI) measures, and also underwent reassessment 3 months after stroke. Bivariate analysis and multivariate linear regression models were used to predict the motor scores (Fugl-Meyer assessment, FMA) at 3 months post-stroke. With bivariate analysis, better motor outcome significantly correlated with (1) less initial motor impairment and disability, (2) less corticospinal tract injury, (3) the initial presence of MEPs, (4) stronger baseline motor fMRI activations. In multivariate analysis, incorporating neuroimaging data improved the predictive accuracy relative to only clinical and neurophysiological assessments. Baseline fMRI activation in SMA was an independent predictor of motor outcome after stroke. A multimodal model incorporating fMRI and clinical measures best predicted the motor outcome following stroke. fMRI measures obtained early after stroke provided independent prediction of long-term motor outcome.
KeywordsStroke Motor deficits Outcome prediction Functional magnetic resonance imaging Diffusion tensor imaging Motor evoked potentials
This study was funded by grants of the National Natural Science Foundation of China (no. 81530038, 81501193, 81701299), Jiangsu Province Foundation of China (no. BK20141373), the special scientific research fund of public welfare profession of national health and family planning commission of China (no. 201402019) and Independent research project in State Key Laboratory of Analytical Chemistry for Life Science (no. 5431ZZXM1716).
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee (the Internal Review Board of Jinling Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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