Internal maxillary artery to intracranial artery bypass: a case series of 31 patients with chronic internal carotid/middle cerebral arterial-sclerotic steno-occlusive disease

Objective: To evaluate the effectiveness of internal maxillary artery (IMA) – radial artery graft (RAG) – middle cerebral artery (MCA) bypass surgery for chronic arterial-sclerotic severe stenosis or occlusion of the internal carotid artery (ICA) or MCA.

Methods: A retrospective study was conducted in 31 patients with ischemic cerebrovascular disease who underwent bypass surgery of the IMA with a RAG of the MCA. Twenty-seven patients had complete occlusion of the ICA or MCA, and four patients had severe stenosis of the M1 segment of the MCA.

Results: Patent IMA-RAG-MCA in 30 (96.8%) patients was confirmed by angiography after surgery. One case developed a new motor aphasia due to unsuccessful bypass. Eleven transient ischemic attacks (TIA) and five ischemic strokes resolved following surgery. The other 14 cases showed some improvement without ischemic events at one month following surgery. Prior to surgery, mean ± SD National Institute of Health Stroke Scale (NIHSS) score was 5.4 ± 1.1 in the ischemic stroke group. In the first month post-procedure, the NIHSS score decreased significantly to 3.8 ± 1.2, (p < 0.01). Perfusion weighted imaging (PWI) or computed tomography perfusion (CTP) indicated improved hemodynamics in 30 patients. In addition, seven patients demonstrated improved glucose metabolism on 18-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography (PET) postoperatively. No new neurological deficit occurred in the 30 patients during a 2.19 ± 1.59 years of follow-up.

Conclusions: By supplying an adequate flow to a larger flow territory of chronically stenotic/occlusive major cerebral arteries, IMA bypass surgery is efficient for restoring hemodynamics in selected patients and improving their neurological deficits.     

Atherosclerotic plaque burden of middle cerebral artery and extracranial carotid artery characterized by MRI in patients with acute ischemic stroke in China: association and clinical relevance

Objectives: This study sought to compare the atherosclerotic plaque burden between middle cerebral artery (MCA) and extracranial carotid artery (ECA) in ischemic stroke patients using high-resolution, black-blood (HR BB) MRI and to investigate the relationship between plaque burden found in both arteries and stroke severity.

Methods: All subjects with recent ischemic stroke underwent MCA and ECA HR BB MRI at 3.0 Tesla. For each artery segment, the thickness, area and signal intensities of plaques were recorded. Plaque burden, as measured by normalized wall index (NWI = wall area/total vessel area × 100%) were calculated. All patients received a clinical stroke severity score as measured by the National Institutes of Health Stroke Scale (NIHSS) scores at the time of admission.

Results: A total of 65 stroke subjects were included in the final analysis. MCA exhibited significantly greater NWI than the ipsilateral ECA (symptomatic MCA vs. ECA: 58.04 ± 8.19 vs. 37.53 ± 10.25, p < 0.001; asymptomatic MCA vs. ECA: 53.80 ± 4.49 vs. 34.85 ± 4.27, p < 0.001, respectively). NWI in symptomatic MCA and ECA were significantly associated with NIHSS scores (r = 0.779 vs. 0.645; p < 0.001 respectively). Moreover, stronger statistical correlations between NIHSS scores and NWI were found in MCA, as compared with ECA during multivariate linear regression analysis.

Conclusion: Greater atherosclerotic plaque burden and a closer association with stroke severity were found for the MCA as compared to the ipsilateral ECA. Identification of MCA plaque lesions by MRI may be helpful for developing more aggressive strategies for stroke prevention.     

Dry eye in chronic stroke patients with hemiplegia: A cross-sectional study

ABSTRACT

Objective: Dry eye is reported to be associated with several neurological diseases. The aim of this study is to evaluate the patients with hemiplegia after stroke for dry eye and compare their results with a control group.

Materials and methods: Forty-five patients with hemiplegia and 45 individuals as the control group were included in the study. Tear function tests (Schirmer and tear breakup time) and a dry eye questionnaire for dry eye symptoms (ocular surface disease index) were performed and the results of the two groups were compared.

Results: Schirmer test results were significantly lower in the post-stroke hemiplegia group compared to the control group (11.3 ± 8.2 mm and 20.6 ± 11.6 mm, respectively, p < .001). Tear breakup time results were significantly lower in the post-stroke hemiplegia group compared to the control group (7.9 ± 3.1 s and 12.1 ± 4.3 s, respectively, p < .001). Ocular surface disease index scores were not significantly different between hemiplegia and control groups (21.6 ± 20.0 and 19.8 ± 13.9, respectively, p = .635). Schirmer scores lower than 10 mm (60% and 30%, p < .001) and tear breakup time results lower than 10 s (65.6% and 28.9%, p < .001) were also higher in the hemiplegia group compared to control group.

Conclusion: We found lower Schirmer test and tear breakup time results and similar OSDI scores in hemiplegia patients compared to controls. Hemiplegia patients may have dry eye without typical symptoms. This should be taken into consideration in the follow-up and rehabilitation of post-stroke hemiplegia patients.     

Transcranial Alternating Current Stimulation Reduces Network Hypersynchrony and Persistent Vertigo

ObjectivesPersistent oscillating vertigo that occurs after entrainment to periodic motion is known as Mal de Débarquement Syndrome (MdDS). Down-modulation of this oscillating vertigo is associated with reduction in long-range resting-state functional connectivity between fronto-parieto-occipital regions. In order to determine the association between this oscillating vertigo and hypersynchrony as measured by the auditory steady-state response (ASSR), we investigated the differences in ASSR between individuals with MdDS and healthy controls as well as the change in ASSR in individuals with MdDS before and after treatment with transcranial alternating current stimulation (tACS).Materials and MethodsIndividuals with treatment refractory MdDS lasting at least six months received single administrations of fronto-parieto-occipital tACS in an “n-of-1” double-blind randomized design: alpha-frequency in-phase, alpha-frequency antiphase, and gamma frequency antiphase control. The treatment protocol that led to the most acute reduction in symptoms and improved balance was administered for 10–12 sessions given over three days (each session 20-min at 2–4 mA).ResultsTwenty-four individuals with MdDS participated (mean age 53.0 ± 11.8 years [range: 22–66 years, median: 57.0 years]; mean duration of illness 38.6 ± 53.4 months [range: 6–240 months, median: 18.0 months]). Individuals with MdDS had elevated ASSR compared to healthy controls at baseline (t₁₁ = 5.95, p < 0.001). There was a significant decrease in the 40 Hz-ASSR response between responders compared to nonresponders to tACS (t-test, t₁₅ = −2.26, p = 0.04). Both in-phase and anti-phase alpha tACS lead to symptom improvement but only antiphase alpha-tACS led to a significant decrease of 40 Hz-ASSR (t-test, t₁₂ = −9.6, p < 0.001).ConclusionsOur findings suggest that tACS has the potential to reduce network-level hypersynchrony and pathological susceptibility to entrainment by sensory input. To the best of our knowledge, this is the first successful demonstration of desynchronization by noninvasive brain stimulation leading to reduced vertigo. Other disease states associated with pathological functional coupling of neuronal networks may similarly benefit from this novel approach.     

Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis

Background: Previous reports have suggested that action observation training (AOT) is beneficial in enhancing the early learning of new motor tasks; however, EEG-based investigation has received little attention for AOT.

Objective: The purpose of this study was to illustrate the effects of AOT on hand dexterity and cortical activation in patients with post-stroke hemiparesis.Method: Twenty patients with post-stroke hemiparesis were randomly divided into either the experimental group (EG) or control group (CG), with 10 patients in each group. Prior to the execution of motor tasks (carrying wooden blocks from one box to another), subjects in the EG and CG observed a video clip displaying the execution of the same motor task and pictures showing landscapes, respectively. Outcome measures included the box and block test (BBT) to evaluate hand dexterity and EEG-based brain mapping to detect changes in cortical activation.

Results: The BBT scores (EG: 20.50 ± 6.62 at pre-test and 24.40 ± 5.42 at post-test; CG: 20.20 ± 6.12 at pre-test and 20.60 ± 7.17 at post-test) revealed significant main effects for the time and group and significant time-by-group interactions (p < 0.05). For the subjects in the EG, topographical representations obtained with the EEG-based brain mapping system were different in each session of the AOT and remarkable changes occurred from the 2nd session of AOT. Furthermore, the middle frontal gyrus was less active at post-test than at pre-test.

Conclusions: These findings support that AOT may be beneficial in altering cortical activation patterns and hand dexterity.     

Validity of the ActiGraph activity monitor for individuals who walk slowly post-stroke

Background Slow and asymmetric gait post-stroke may reduce the accuracy of accelerometers (e.g. ActiGraph [AG]) to measure activity.

Objectives To (1) determine the validity of AG step counts post-stroke; (2) develop guidelines for low frequency extension filter (LFE) use; and (3) determine the feasibility of daily accelerometer wear.

Methods Adults with (n = 33) and without stroke (n = 20) wore three devices for approximately 7 h on a single day: ankle AG, waist AG, and a reference accelerometer at the ankle (REFA). AG step counts processed with and without the LFE were compared to REFA with paired difference tests. Agreement was measured with intraclass correlation coefficients (ICC_3,1). Relationships between error (AG – REFA) and motor impairment and gait performance were plotted to determine a threshold for LFE application. A feasibility questionnaire was distributed to participants to investigate the applicability of the AG in clinical populations.

Results Step counts from ankle AG in the stroke group (p = 0.53) and waist AG in the healthy group (p = 0.10) were similar to REFA. Waist AG under-counted, and ankle and waist AG with LFE over-counted steps in the stroke group (all p < 0.0001). ICC_3,1 ranged from 0.70 to 0.82 (stroke) and 0.79–0.92 (healthy). Ankle AG error and stance time symmetry (stroke) were correlated (r = 0.41, p = 0.02); however, no threshold for LFE application was revealed. Ankle AG was rated very comfortable by 26/33 participants with stroke and 12/20 healthy participants.

Conclusions The AG worn at the unaffected ankle without LFE produced the most accurate step count in people with stroke. We were unable to establish guidelines for LFE use.     

Effect of low-intensity pure tone auditory stimulation on patients with rapid eye movement sleep behavior disorder

Objective: This study aimed to investigate the influence of low-intensity pure tone auditory stimulation on patients with rapid eye movement (REM), sleep behavior disorder (RBD), and attempt to identify a new method of RBD intervention.

Methods: Patients diagnosed with idiopathic RBD (iRBD) or symptomatic RBD (sRBD) were given auditory stimulation of low-intensity pure tones during their REM sleep. Sleep parameters including sleep process, sleep architecture as well as eye movements (EMs) frequency, and amplitude were recorded by polysomnography monitoring at pre-, intra-, and post-stimulation.

Results: Thirteen iRBD and 18 sRBD patients completed this study. Auditory stimulation significantly reduced the EMs frequency and amplitude in iRBD and sRBD patients (p < 0.05). In the iRBD group, the intra-stimulated FSL increased significantly than the pre-stimulated FSL (p < 0.05). After stimulation, patients had similar sleep latency (FSL), rapid eye movement sleep latency (RSL) and periodic limb movements in sleep (PLMS) compared with control. In the sRBD group, the intra-stimulated total sleep time, sleep efficiency was significantly increased, whereas the RSL and PLMS were significantly reduced compared with the pre-stimulated ones (all p < 0.05). The sRBD patients had similar time in bed, FSL and RBD episodes compared with control (all p < 0.05) in spite of significant difference before stimulation (all p < 0.05). However, the sleep architecture was not influenced by the stimulation despite the decrease in N3% in iRBD group (p < 0.05).

Conclusion: Low-intensity pure tone auditory stimulation may be a potentially effective intervention for RBD, especially for sRBD.     

Physical activity in chronic home-living and sub-acute hospitalized stroke patients using objective and self-reported measures

Background: Despite confirmed reduced physical activity (PA) after stroke in various stages of recovery, the type of activities stroke patients executed and the time spent at different activity levels have not been sufficiently verified with stroke-validated assessment tools.

Design: Observational study.

Objective: To determine PA of sub-acute stroke patients hospitalized in a rehabilitation centre (HOS) compared to chronic home-living stroke patients (HOM) using objective and self-reported measures during 2 weekdays and 1 weekend day.

Methods: Fifteen HOS and 15 HOM patients wore a Sense Wear Pro 2 accelerometer (METs*minutes/24 h) and a knee-worn pedometer Yamax Digi Walker SW 200 (steps) and filled in a coded activity diary (kcal/24 h; METs*minutes/24 h) during three consecutive days.

Results: In HOM significantly more steps (steps_{total HOM} = 18722.6 ± 10063.6; steps_{total HOS} = 7097.8 ± 5850.5) and higher energy expenditure (EE) levels (EE_{total HOM} = 7759.34 ± 2243.04; EE_{total HOS} = 5860.15 ± 1412.78) were measured. In this group less moderate activity (≥3–6 ≤ METs) was performed on a weekday (p_day1 = 0.006; p_day2 = 0.027) and in total (p = 0.037). Few therapy hours (physical, occupational and speech therapy, and psychological support) were provided in HOM compared to HOS (p < 0.001). Vigorous activities were only seen in HOM. In both groups few patients executed sport activities.

Conclusions: In HOM significantly more steps were performed and higher EE values were measured. However, participation in moderate activities and time spent on therapy were less in HOM. Evaluating PA with quantitative measures is feasible in both chronic home-living and sub-acute hospitalized patients with stroke.     

Cognitive function and insulin resistance in elderly patients with type 2 diabetes

Purpose: To explore the relationship between cognitive impairment and insulin resistance (IR) in elderly patients with type-2 diabetes mellitus.

Materials and methods: Two hundred and twelve elderly patients with type-2 diabetes were enrolled in this study and assigned into either the cognitive impairment group (n = 100) or the normal cognitive group (n = 112). Gender, age, education, body mass index (BMI), total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine (Cr), fasting plasma glucose, fasting insulin (FINS) and homeostasis model of assessment for IR index (HOMA-IR) were compared between the two groups. Multifactorial logistic regression analysis was performed.

Results: In cognitive impairment group, education level (33.00 vs 53.57%, p < 0.01) was lower, the level of BMI [(28.7 ± 4.5) kg/m² vs (23.9 ± 3.7) kg/m², p < 0.01], FINS [(21.8 ± 5.3) mU/L vs (12.9 ± 3.9) mU/L, p < 0.01], HOMA-IR [(6.9 ± 1.7) vs (3.9 ± 0.9), p < 0.01] were higher than the control group. In the logistic regression, education level (B = –0.996, p = 0.03), FINS (B = 1.120, p < 0.01) and HOMA-IR (B = 1.301, p < 0.01) were independent factors.

Conclusions: Our study demonstrates that the education level, FINS and HOMA-IR were independent factors of cognitive impairment in elderly patients with type-2 diabetes. IR is an important risk factor and higher education level in a protective factor for the cognitive impairment in elderly patients with type-2 diabetes.     

Exposure to gamma tACS in Alzheimer’s disease: A randomized,double-blind,sham-controlled,crossover, pilot study

ObjectiveTo assess whether exposure to non-invasive brain stimulation with transcranial alternating current stimulation at γ frequency (γ-tACS) applied over Pz (an area overlying the medial parietal cortex and the precuneus) can improve memory and modulate cholinergic transmission in mild cognitive impairment due to Alzheimer’s disease (MCI-AD).MethodsIn this randomized, double-blind, sham controlled, crossover pilot study, participants were assigned to a single 60 min treatment with exposure to γ-tACS over Pz or sham tACS. Each subject underwent a clinical evaluation including assessment of episodic memory pre- and post-γ-tACS or sham stimulation. Indirect measures of cholinergic transmission evaluated using transcranial magnetic stimulation (TMS) pre- and post-γ-tACS or sham tACS were evaluated.ResultsTwenty MCI-AD participants completed the study. No tACS-related side effects were observed, and the intervention was well tolerated in all participants. We observed a significant improvement at the Rey auditory verbal learning (RAVL) test total recall (5.7 [95% CI, 4.0 to 7.4], p < 0.001) and long delayed recall scores (1.3 [95% CI, 0.4 to 2.1], p = 0.007) after γ-tACS but not after sham tACS. Face-name associations scores improved during γ−tACS (4.3 [95% CI, 2.8 to 5.8], p < 0.001) but not after sham tACS. Short latency afferent inhibition, an indirect measure of cholinergic transmission evaluated with TMS, increased only after γ-tACS (0.31 [95% CI, 0.24 to 0.38], p < 0.001) but not after sham tACS.Conclusionsexposure to γ-tACS over Pz showed a significant improvement of memory performances, along with restoration of intracortical connectivity measures of cholinergic neurotransmission, compared to sham tACS.     

Intra- and inter-rater reliability of the 10-meter ambulation test in hemiparesis is better barefoot at maximal speed

Objectives Reliability of clinical tests to evaluate ambulation in chronic hemiparesis may vary according to the testing condition. The 10-meter ambulation test (AT10) assesses walking speed and step length over 10 m, starting and ending in seated position. In the present study, we compared the intra- and inter-reliability of AT10 in chronic hemiparesis in four different conditions: with shoes and barefoot, at free and maximal safe speed.

Methods Ten patients with hemiparesis, >1 year post-stroke (age 45 ± 12, time since stroke 16 ± 9 months, mean ± SD) participated in the reliability study (registration, ID-RCB-2017-A00090-53). All patients performed the AT10 twice, one week apart, in each of the four conditions. The number of steps and time to complete the task were manually recorded by four independent raters. The main outcome measurements were the intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean raw differences (DIFF) of the three parameters of AT10 (speed, step length, and cadence) in each of the four conditions. Effects of wearing shoes and speed condition were explored using ANOVA.

Results Across all conditions, mean intra- and inter-rater ICCs were, respectively, 98.5 ± 0.1 and 99.9 ± 0.1% for speed, 98.3 ± 0.1 and 99.7 ± 0.2% for step length, and 96.5 ± 0.1 and 98.9 ± 0.6% for cadence. Mean intra- and inter-rater CV for speed were 0.051 ± 0.016 and 0.022 ± 0.002, respectively. Intra-rater reliability of speed assessments was higher at maximal than at free speed (ICC, CV, DIFF, p < 0.05). At free speed, intra-rater ICCs were higher barefoot than with shoes (p < 0.05).

Discussion Performing the 10-meter ambulation test barefoot at maximal speed optimizes its reliability.     

Effect of intensive motor training with repetitive transcranial magnetic stimulation on upper limb motor function in chronic post-stroke patients with severe upper limb motor impairment

Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment.

Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment.

Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl–Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention.

Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6–18.0; WMFT: 3.6–3.3, p < 0.001).

Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.     

Impaired dynamic cerebral autoregulation in middle cerebral artery stenosis

Abstract

Background and purpose: Analysis of dynamic cerebral autoregulation during transient falls in blood pressure is considered a sensitive and convenient method for evaluating patients with carotid artery stenosis. To this point, there have been few reports on the efficacy of using the thigh cuffs technique to analyse middle cerebral artery (MCA) stenosis. If it could be determined whether cerebral blood flow can be maintained (autoregulated) during sudden falls in arterial blood pressure (ABP), then it might be possible to identify patients with MCA stenosis who are at risk of stroke.

Methods: We used the thigh cuff technique to estimate dynamic cerebral autoregulation in 57 patients with MCA stenosis and 72 normal controls. After a stepwise fall in arterial blood pressure, we determined the rate of the rise of MCA blood velocity and compared it with the rate of the rise of arterial blood pressure. In this manner, the dynamic cerbral autoregulation of 11 patients undergoing MCA M1 stent angioplasty was estimated both pre- and post-operation.

Results: The autoregulatory index (ARI) was significantly reduced in patients with stenosed/occluded MCA (3.24 ± 1.52), as compared with normal controls (5.25 ± 1.39; p<0.001) (results reported as mean ± SD). Poor ARI values are usually observed in patients with a higher degree of stenosis and particularly in patients with insufficient collateral compensation. ARI was significantly reduced in severe stroke patients (modified ranking scale≥1), as compared with asymptomatic or TIA patients (p<0.05). After MCA stent angioplasty was performed, there was a significant improvement in ARI in 11 subjects, which caused a mean increase in ARI from 2.08 ± 1.10 to 3.80 ± 1.36 (p=0.008).

Conclusions: Dynamic cerebral autoregulation is impaired in patients with middle cerebral artery stenosis. Assessing dynamic cerebral autoregulation may allow a subgroup of patients with MCA stenosis who are at risk of hemodynamic stroke to be identified. Dynamic cerebral disautoregulation in patients with severe MCA stenosis is mostly remedied by stent angioplasty.     

Predictors of dependence after MCA ischemic stroke submitted to thrombolysis

Objectives: Stroke is one of the most common causes of disability-adjusted life years worldwide. The aim of this study is to identify variables associated with dependence at 3 months and also after the first 3 months after the first-ever ischemic stroke (IS) in middle cerebral artery (MCA) territory submitted to intravenous thrombolysis (IVT).

Methods: A single-center cohort study of patients with first-ever MCA IS treated with IVT at the Hospital de Clínicas, Universidade Federal do Paraná, was followed over 5 years. Logistic regression was performed to determine predictors of early and late dependence.

Results: A total of 144 patients were included; 48.6% women, and 47.2% were dependent at 3 months after stroke. NIHSS at admission (OR = 1.3, 95%CI = 1.16–1.45, p < 0.001), large artery atherosclerosis (LAA) stroke (OR = 4.11, 95%CI = 1.31–12.85, p = 0.014) and pneumonia during hospitalization (OR = 9.17, 95%CI = 1.42–59.07, p = 0.019) were predictors for early dependence. For the late dependence analyses, 99 patients were included; 49.5% women and 39.4% were dependent after 3 months of stroke. NIHSS at admission (OR = 1.33, 95%CI = 1.15–1.54, p < 0.001), pneumonia during hospitalization (OR = 11.08, 95%CI = 1.45–84.73, p = 0.019) and seizure after discharge (OR = 5.82, 95%CI = 1.06–32.01, p = 0.040) were predictors for late dependence.

Discussion: .Dependence is an important indicator of the efficacy of stroke care. Besides it was not possible to evaluate rehabilitation, this is the first study on predictors of post-stroke dependence that focus exclusively on patients with first-ever MCA IS submitted to IVT. NIHSS, LAA stroke, in-hospital pneumonia and seizures after discharge were associated with dependence after first-ever MCA IS submitted to IVT.     

Influence of hemodynamics on enlarged perivascular spaces in atherosclerotic large vessel disease

ABSTRACT

Objectives: Enlarged perivascular spaces (EPVS) are often observed in small vessel disease on T2-weighted images. However, their role in ischemic conditions caused by cerebral large vessel disease remains unclear. We evaluated EPVS in patients with hemodynamic compromise associated with atherosclerotic large vessel disease and aimed to identify the pathophysiology of EPVS.

Methods: We examined 28 adults with atherosclerotic large vessel disease. EPVS numbers in the basal ganglia and the centrum semiovale were assessed. For each affected hemisphere, the total numbers of EPVS were compared with those on the unaffected side. EPVS in the impaired hemodynamics group were compared with those in the unimpaired hemodynamics group. Moreover, EPVS were compared in the presence/absence of large stroke.

Results: The number of EPVS was significantly increased on the affected side in the centrum semiovale (p = 0.023), particularly in the impaired hemodynamics group (p = 0.006). Moreover, in the small stroke subgroup of the impaired hemodynamics group, the number of EPVS was significantly increased on the affected side (p = 0.002), although this number was insignificant in the large ischemic stroke subgroup.

Conclusions: The number of EPVS was increased in patients with atherosclerotic large vessel disease with hemodynamic compromise and decreased in the presence of a large stroke. EPVS might act as fluid absorbers in a hemodynamically compromised state until the occurrence of an ischemic stroke.     

The effect of gamma oscillations in boosting primary motor cortex plasticity is greater in young than older adults

ObjectiveIn healthy subjects, the long-term potentiation (LTP)-like plasticity of the primary motor cortex (M1) induced by intermittent theta-burst stimulation (iTBS) can be boosted by modulating gamma (γ) oscillations through transcranial alternating current stimulation (tACS). γ-tACS also reduces short-interval intracortical inhibition (SICI). We tested whether the effects of γ-tACS differ between young (YA) and older adults (OA).MethodsTwenty YA (27.2 ± 2.7 years) and twenty OA (65.3 ± 9.5 years) underwent iTBS-γ tACS and iTBS-sham tACS in randomized sessions. In a separate session, we delivered γ-tACS alone and recorded SICI during stimulation.ResultsiTBS-sham tACS produced comparable motor evoked potential (MEP) facilitation between groups. While iTBS-γ tACS boosted MEP facilitation in both the YA and OA groups, the magnitude of its effect was significantly lower in OA. Similarly, γ-tACS-induced modulation of GABA-A-ergic neurotransmission, as tested by SICI, was reduced in OA. The effect of iTBS-γ tACS negatively correlated with the age of OA subjects.ConclusionsMechanisms underlying the effects of γ oscillations on LTP-like plasticity become less efficient in older adults. This could reflect age-related changes in neural elements of M1 resonant to γ oscillations, including GABA-A-ergic interneurons.SignificanceThe beneficial effect of γ-tACS on iTBS-induced plasticity is reduced in older adults.     

Neuroprotective effect of ischemic preconditioning via modulating the expression of cerebral miRNAs against transient cerebral ischemia in diabetic rats

Objectives: In this study, we aimed to evaluate the effect of the Ischemic preconditioning (IPreC) on the expression profile of cerebral miRNAs against stroke by induced transient middle cerebral artery occlusion (MCAo) in diabetic rats.

Methods: Eighty male Spraque Dawley rats were allocated to eight groups. In order to evaluate the expression profile of miRNAs, we induced transient MCAo seven days after STZ-induced diabetes (DM). Also we performed IPreC 72 h before transient MCAo to assess whether IPreC could have a neuroprotective effect against ischemia-reperfusion injury.

Results: The general characteristics of STZ-treated rats included reduced body weight and elevated blood glucose levels compared to non-diabetic ones. We demonstrated that miRNA expression profiles, which are determined for biological functions such as aquaporin 4 formation (miR-29b-2, miR-124a-3p, miR-130a, miR-223 and miR-320a), glutamate toxicity (miR107, miR-145, miR-223), salvageable ischemic area (miR-9a, miR-19b, miR-29b-2, miR-341, miR-339–5p, miR-15–5p, miR-99b-5p), and neoangiogenesis (let-7f-5p, miR-126a and miR-322–3p), were regulated following IPreC. Ischemic preconditioning before cerebral ischemia significantly reduced infarction size compared with the other groups [IPreC + MCAo (27 ± 11 mm³) vs. MCAo (109 ± 15 mm³) p < 0.001; DM + IPreC + MCAo (38 ± 9 mm³) vs. DM + MCAo (165 ± 41 mm³) p < 0.001, respectively].

Discussion: The study results revealed the neuroprotective effects of ischemic preconditioning, supported with the upregulated pro-survival miRNAs in MCA infarcts.     

Association of renal function with ambulation in mild acute stroke patients

Background: Renal dysfunction has affected the functional outcome after stroke. However, the association of renal function with walking endurance after stroke is poorly understood.

Objectives: This study aimed to investigate the relationship between renal function and walking endurance and speed in mild acute stroke patients.

Methods: Eighty-nine patients with mild acute stroke were enrolled. Walking endurance and speed were assessed by the 6-minute walk test (6MWT) and comfortable and maximal 10-meter walk tests (10MWT) within 7 days of hospital admission. Stroke severity was assessed using the National Institutes of Health stroke scale (NIHSS) on admission. The estimated glomerular filtration rate (eGFR) was calculated based on creatinine levels as a renal function. Pearson’s correlation coefficients were calculated between eGFR and walking ability. Multivariate regression analysis was used to investigate the relationship between eGFR and walking ability in mild acute stroke patients.

Results: The 6MWT distance was significantly correlated with eGFR (r = 0.212, p = .046). On multivariate regression analysis, the 6MWT was significantly associated with age (p = .029), body mass index (p = .020), NIHSS score (p = .016), and eGFR (p = .028), whereas the comfortable 10MWT was significantly associated with the NIHSS score alone (p = .009) and the maximal 10MWT was significantly associated with age (p = .032) and NIHSS score (p = .007).

Conclusion: The eGFR based on creatinine levels of acute stroke patients may be important factor to predict the walking endurance in mild acute stroke patients.     

Trunk control and functionality in children with spastic cerebral palsy

ABSTRACT

Purpose: To investigate the relationship between trunk control in sitting and functionality in children with spastic cerebral palsy (CP).

Methods: Fifty-eight children with spastic CP were included in the study. Functional abilities were evaluated with the Gross Motor Function Measurement-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory Functional Skills domain (PEDI-FSD). Trunk control in sitting was tested with the Trunk Control Measurement Scale (TCMS) and the Trunk Impairment Scale (TIS). The scores of the TCMS and TIS were compared with GMFM-88 and PEDI-FSD with Spearman correlation analysis.

Results: The total score of GMFM-88 was signi?cantly correlated with the total score of TCMS (r_ho = 0.90, p < 0.01) and TIS (r_ho = 0.78, p < 0.01). The total score of PEDI-FSD was also signi?cantly correlated with the total score of TCMS (r_ho = 0.76, p < 0.01) and TIS (r_ho = 0.72, p < 0.01).

Conclusions: The evaluation of trunk control can provide valuable information for functional abilities of children with spastic CP.     

Efficacy of elaborated semantic features analysis in Aphasia: a quasi-randomised controlled trial

ABSTRACT

Background: Word finding difficulty is one of the most common features of aphasia. Semantic Features Analysis (SFA) directly aims to improve word finding in people with aphasia. Evidence from systematic reviews suggests that SFA leads to positive outcomes, yet the evidence comprises single case studies and case series. There is a need to evaluate the efficacy of SFA in controlled group studies/trials.

Aims: To evaluate the efficacy of Elaborated Semantic Feature Analysis (ESFA) for word finding in people with aphasia. We investigated: (a) the efficacy of ESFA versus a delayed therapy/control, (b) the efficacy of two therapy approaches – individual versus a combination of individual and group therapy.

Methods and procedures: We ran a multi-centre, quasi-randomised controlled trial, nested in a larger study (Thales-Aphasia). Participants were recruited from community settings. They had to be people with aphasia due to stroke at least four months post-onset. Participants were randomized to individual vs combination vs delayed therapy/control groups. Both therapy groups had 3 h of ESFA per week for 12 weeks. Delayed therapy/control group had no intervention for 12 weeks and were then randomized to either individual or combination therapy. The primary outcome was confrontation naming. Secondary outcomes were the Boston Naming Test, Discourse, the Functional Assessment of Communication Skills for adults (ASHA–FACS), the Stroke and Aphasia Quality of Life scale (SAQOL-39g), the General Health Questionnaire-12 item, and the EQ-5D.

Outcomes and Results: Of the 72 participants of the Thales-Aphasia project, 58 met eligibility criteria for speech-language therapy and 39 were allocated to ESFA. The critical p-value was adjusted for multiple comparisons (.005). For the therapy versus control comparison, there was a significant main effect of time on the primary outcome (p < .001, η²_p = .42) and a significant interaction effect (p = .003, η²_p = .21). An interaction effect for the SAQOL-39g (p = .015, η²_p = .11) and its psychosocial domain (p = .013, η²_p = .12) did not remain significant after Bonferroni adjustment. For the individual versus combination ESFA comparison, there were significant main effects of time on the primary outcome (p < .001, η²_p = .49), the BNT (p < .001, η²_p = .29) and the ASHA-FACS (p = .001, η²_p = .18). Interaction and group effects were not significant.

Conclusion: Though underpowered, this study provides evidence on the efficacy of ESFA to improve word finding in aphasia, with gains similar in the two therapy approaches.