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Wallerian Degeneration of the Corticofugal Tracts in Chronic Stroke: A Pilot Study Relating Diffusion Tensor Imaging, Transcranial Magnetic Stimulation, and Hand Function
Påvel G. Lindberg, MSc1*,
Pernille H. B. Skejø, MD2,
Elizabeth Rounis, PhD3,
Zoltan Nagy, MSc4,
Christina Schmitz, PhD4,
Helena Wernegren, MSc5,
Annika Bring, MSc6,
Margareta Engardt, PhD7,
Hans Forssberg, PhD4,
Jörgen Borg, PhD8
1 Uppsala University Hospital, Uppsala, Karolinska Institutet, Stockholm, and Danderyd Hospital, Stockholm, Sweden
2 Department of Neuroradiology, Odense Hospital, Odense, Denmark
3 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
4 Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
5 Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
6 Department of Physical Therapy, Uppsala University Hospital, Uppsala, Sweden
7 Physical Therapy, Uppsala University Hospital, Uppsala, Sweden
8 Department of Neuroscience, Uppsala University Hospital, Uppsala, Sweden
* To whom correspondence should be addressed. E-mail: Pavel.Lindberg{at}rehab.uu.se.
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Abstract |
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Objective. This study tested the hypothesis that degeneration of the corticofugal tracts (CFTs) is related to poor functional outcome in the upper limb after stroke. Methods. The authors used diffusion tensor imaging to determine the degree of white matter integrity of the CFT (FAAH/UH) in chronic stroke patients and controls. The functional integrity of the corticospinal pathway was examined using transcranial magnetic stimulation. Recruitment curves and silent period duration were measured. The relationship between FAAH/UH and functional outcome of the upper limb was also assessed using a battery of upper limb function tests. Results. In patients, FAAH/UH correlated positively with the slope of recruitment curves (RCAH/UH) and grip strength. FAAH/UH also correlated negatively with the silent period duration (SPAH/UH). According to the FAAH/UH, patients were also classified into groups with minimal or extensive Wallerian degeneration (WD). Patients with more extensive WD had poorer grip strength, dexterity, and range of movement. Conclusions. The authors’ results suggest that structural and functional integrity of the CFT is essential to maintain function of the upper limb after stroke.
First published on May 16, 2007, doi:10.1177/1545968307301886
Neurorehabilitation and Neural Repair 2007;21:551.
A more recent version of this article appeared on December 1, 2007
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