Cortical Reorganization of Early Somatosensory Processing in Hemiparetic Stroke

Jordan N Williamson, William A Sikora, Shirley A James, Nishaal J Parmar, Louis V Lepak, Carolyn F Cheema, Hazem H Refai, Dee H Wu, Evgeny V Sidorov, Julius P A Dewald, Yuan Yang, Jordan N Williamson, William A Sikora, Shirley A James, Nishaal J Parmar, Louis V Lepak, Carolyn F Cheema, Hazem H Refai, Dee H Wu, Evgeny V Sidorov, Julius P A Dewald, Yuan Yang

Abstract

The cortical motor system can be reorganized following a stroke, with increased recruitment of the contralesional hemisphere. However, it is unknown whether a similar hemispheric shift occurs in the somatosensory system to adapt to this motor change, and whether this is related to movement impairments. This proof-of-concept study assessed somatosensory evoked potentials (SEPs), P50 and N100, in hemiparetic stroke participants and age-matched controls using high-density electroencephalograph (EEG) recordings during tactile finger stimulation. The laterality index was calculated to determine the hemispheric dominance of the SEP and re-confirmed with source localization. The study found that latencies of P50 and N100 were significantly delayed in stroke brains when stimulating the paretic hand. The amplitude of P50 in the contralateral (to stimulated hand) hemisphere was negatively correlated with the Fügl-Meyer upper extremity motor score in stroke. Bilateral cortical responses were detected in stroke, while only contralateral cortical responses were shown in controls, resulting in a significant difference in the laterality index. These results suggested that somatosensory reorganization after stroke involves increased recruitment of ipsilateral cortical regions, especially for the N100 SEP component. This reorganization delays the latency of somatosensory processing after a stroke. This research provided new insights related to the somatosensory reorganization after stroke, which could enrich future hypothesis-driven therapeutic rehabilitation strategies from a sensory or sensory-motor perspective.

Keywords: EEG; cortical reorganization; hemiparetic stroke; sensorimotor system; somatosensory evoked potentials.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Experimental Setup.
Figure 2
Figure 2
Contralateral Somatosensory Evoked Potential (SEP) response to finger stimulation. Stroke-P (red): paretic hand was stimulated. Stroke-N (blue): non-paretic hand was simulated. Control (black): dominant hand was stimulated.
Figure 3
Figure 3
Ipsilateral Somatosensory Evoked Potential (SEP) response to finger stimulation. Stroke-P (red): paretic hand was stimulated. Stroke-N (blue): non-paretic hand was simulated. Control (Black): dominant hand was stimulated.
Figure 4
Figure 4
Latency of contralateral (to stimulated hand) Somatosensory Evoked Potential (SEP) component P50. Stars indicate statistically significant differences between groups (control, stroke paretic hand (Stroke-P) and stroke non-paretic hand (Stroke-N)) **

Figure 5

Latency of contralateral (to stimulated…

Figure 5

Latency of contralateral (to stimulated hand) Somatosensory Evoked Potential (SEP) component P50. Stars…

Figure 5
Latency of contralateral (to stimulated hand) Somatosensory Evoked Potential (SEP) component P50. Stars indicate a statistically significant difference between groups (control, stroke paretic hand (Stroke-P) and stroke non-paretic hand (Stroke-N)): ***

Figure 6

Stroke paretic hand: Fügl–Meyer upper…

Figure 6

Stroke paretic hand: Fügl–Meyer upper extremity (FM-UE) score vs. P50 amplitude in the…

Figure 6
Stroke paretic hand: Fügl–Meyer upper extremity (FM-UE) score vs. P50 amplitude in the contralateral (to stimulated hand) hemisphere. There is a significant negative linear relationship between P50 amplitude and FM-UE Score (R = −0.630, p = 0.047).

Figure 7

Laterality Index. Stars indicate statistically…

Figure 7

Laterality Index. Stars indicate statistically significant differences among control, stroke paretic hand (Stroke-P),…

Figure 7
Laterality Index. Stars indicate statistically significant differences among control, stroke paretic hand (Stroke-P), and stroke non-paretic hand (Stroke-N): *

Figure 8

Cortical sources of Somatosensory Evoked…

Figure 8

Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right…

Figure 8
Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right hand was stimulated, and only contralateral (left) cortical sources were detected for P50 and N100.

Figure 9

Cortical sources of SEP components…

Figure 9

Cortical sources of SEP components in stroke when the paretic hand is stimulated.…

Figure 9
Cortical sources of SEP components in stroke when the paretic hand is stimulated. The paretic (right) hand was stimulated, contralateral (left) source activities were detected at the time point of P50, and bilateral source activities (more activities in the ipsilateral (right) hemisphere) are detected at the time point of N100.

Figure 10

Cortical sources of SEP components…

Figure 10

Cortical sources of SEP components in stroke when the non-paretic hand is stimulated.…

Figure 10
Cortical sources of SEP components in stroke when the non-paretic hand is stimulated. Non-paretic (left) hand was stimulated, and contralateral (right) source activities were detected mainly at the time points of P50 and N100.
All figures (10)
Similar articles
References
    1. Virani S.S., Alonso A., Benjamin E.J., Bittencourt M.S., Callaway C.W., Carson A.P., Chamberlain A.M., Chang A.R., Cheng S., Delling F.N., et al. Heart disease and stroke statistics—2020 update: A report from the American Heart Association. Circulation. 2020;141:E139–E596. doi: 10.1161/CIR.0000000000000757. - DOI - PubMed
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Figure 5
Figure 5
Latency of contralateral (to stimulated hand) Somatosensory Evoked Potential (SEP) component P50. Stars indicate a statistically significant difference between groups (control, stroke paretic hand (Stroke-P) and stroke non-paretic hand (Stroke-N)): ***

Figure 6

Stroke paretic hand: Fügl–Meyer upper…

Figure 6

Stroke paretic hand: Fügl–Meyer upper extremity (FM-UE) score vs. P50 amplitude in the…

Figure 6
Stroke paretic hand: Fügl–Meyer upper extremity (FM-UE) score vs. P50 amplitude in the contralateral (to stimulated hand) hemisphere. There is a significant negative linear relationship between P50 amplitude and FM-UE Score (R = −0.630, p = 0.047).

Figure 7

Laterality Index. Stars indicate statistically…

Figure 7

Laterality Index. Stars indicate statistically significant differences among control, stroke paretic hand (Stroke-P),…

Figure 7
Laterality Index. Stars indicate statistically significant differences among control, stroke paretic hand (Stroke-P), and stroke non-paretic hand (Stroke-N): *

Figure 8

Cortical sources of Somatosensory Evoked…

Figure 8

Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right…

Figure 8
Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right hand was stimulated, and only contralateral (left) cortical sources were detected for P50 and N100.

Figure 9

Cortical sources of SEP components…

Figure 9

Cortical sources of SEP components in stroke when the paretic hand is stimulated.…

Figure 9
Cortical sources of SEP components in stroke when the paretic hand is stimulated. The paretic (right) hand was stimulated, contralateral (left) source activities were detected at the time point of P50, and bilateral source activities (more activities in the ipsilateral (right) hemisphere) are detected at the time point of N100.

Figure 10

Cortical sources of SEP components…

Figure 10

Cortical sources of SEP components in stroke when the non-paretic hand is stimulated.…

Figure 10
Cortical sources of SEP components in stroke when the non-paretic hand is stimulated. Non-paretic (left) hand was stimulated, and contralateral (right) source activities were detected mainly at the time points of P50 and N100.
All figures (10)
Similar articles
References
    1. Virani S.S., Alonso A., Benjamin E.J., Bittencourt M.S., Callaway C.W., Carson A.P., Chamberlain A.M., Chang A.R., Cheng S., Delling F.N., et al. Heart disease and stroke statistics—2020 update: A report from the American Heart Association. Circulation. 2020;141:E139–E596. doi: 10.1161/CIR.0000000000000757. - DOI - PubMed
    1. Lo A.C., Guarino P.D., Richards L.G., Haselkorn J.K., Wittenberg G.F., Federman D.G., Ringer R.J., Wagner T.H., Krebs H.I., Volpe B.T., et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N. Engl. J. Med. 2010;362:1772–1783. doi: 10.1056/NEJMoa0911341. - DOI - PMC - PubMed
    1. Millán J.D.R., Rupp R., Mueller-Putz G., Murray-Smith R., Giugliemma C., Tangermann M., Vidaurre C., Cincotti F., Kubler A., Leeb R., et al. Combining brain–computer interfaces and assistive technologies: State-of-the-art and challenges. Front. Neurosci. 2010;4:161. doi: 10.3389/fnins.2010.00161. - DOI - PMC - PubMed
    1. Pollock A., Farmer S.E., Brady M.C., Langhorne P., Mead G.E., Mehrholz J., Van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst. Rev. 2014;11:CD010820. doi: 10.1002/14651858.CD010820.pub2. - DOI - PMC - PubMed
    1. Veerbeek J.M., Langbroek-Amersfoort A.C., Van Wegen E.E., Meskers C.G., Kwakkel G. Effects of robot-assisted therapy for the upper limb after stroke: A systematic review and meta-analysis. Neurorehabilit. Neural Repair. 2017;31:107–121. doi: 10.1177/1545968316666957. - DOI - PubMed
Show all 47 references
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 6
Figure 6
Stroke paretic hand: Fügl–Meyer upper extremity (FM-UE) score vs. P50 amplitude in the contralateral (to stimulated hand) hemisphere. There is a significant negative linear relationship between P50 amplitude and FM-UE Score (R = −0.630, p = 0.047).
Figure 7
Figure 7
Laterality Index. Stars indicate statistically significant differences among control, stroke paretic hand (Stroke-P), and stroke non-paretic hand (Stroke-N): *

Figure 8

Cortical sources of Somatosensory Evoked…

Figure 8

Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right…

Figure 8
Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right hand was stimulated, and only contralateral (left) cortical sources were detected for P50 and N100.

Figure 9

Cortical sources of SEP components…

Figure 9

Cortical sources of SEP components in stroke when the paretic hand is stimulated.…

Figure 9
Cortical sources of SEP components in stroke when the paretic hand is stimulated. The paretic (right) hand was stimulated, contralateral (left) source activities were detected at the time point of P50, and bilateral source activities (more activities in the ipsilateral (right) hemisphere) are detected at the time point of N100.

Figure 10

Cortical sources of SEP components…

Figure 10

Cortical sources of SEP components in stroke when the non-paretic hand is stimulated.…

Figure 10
Cortical sources of SEP components in stroke when the non-paretic hand is stimulated. Non-paretic (left) hand was stimulated, and contralateral (right) source activities were detected mainly at the time points of P50 and N100.
All figures (10)
Figure 8
Figure 8
Cortical sources of Somatosensory Evoked Potential (SEP) components in Healthy Control. The right hand was stimulated, and only contralateral (left) cortical sources were detected for P50 and N100.
Figure 9
Figure 9
Cortical sources of SEP components in stroke when the paretic hand is stimulated. The paretic (right) hand was stimulated, contralateral (left) source activities were detected at the time point of P50, and bilateral source activities (more activities in the ipsilateral (right) hemisphere) are detected at the time point of N100.
Figure 10
Figure 10
Cortical sources of SEP components in stroke when the non-paretic hand is stimulated. Non-paretic (left) hand was stimulated, and contralateral (right) source activities were detected mainly at the time points of P50 and N100.

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