White matter integrity of premotor-motor connections is associated with motor output in chronic stroke patients

Robert Schulz, Hanna Braass, Gianpiero Liuzzi, Vanessa Hoerniss, Patricia Lechner, Christian Gerloff, Friedhelm C Hummel, Robert Schulz, Hanna Braass, Gianpiero Liuzzi, Vanessa Hoerniss, Patricia Lechner, Christian Gerloff, Friedhelm C Hummel

Abstract

Corticocortical functional interactions between the primary motor cortex (M1) and secondary motor areas, such as the dorsal (PMd) and ventral (PMv) premotor cortices and the supplementary motor area (SMA) are relevant for residual motor output after subcortical stroke. We hypothesized that the microstructural integrity of the underlying white matter tracts also plays a role in preserved motor output. Using diffusion-tensor imaging we aimed at (i) reconstructing individual probable intrahemispheric connections between M1 and the three secondary areas (PMd, PMv, SMA) and (ii) examining the extent to which the tract-related microstructural integrity correlates with residual motor output. The microstructural integrity of the tract connecting ipsilesional M1 and PMd was significantly associated with motor output (R = 0.78, P = 0.02). The present results support the view that ipsilesional secondary motor areas such as the PMd might support M1 via corticocortical connections to generate motor output after stroke.

Keywords: Cortical; Diffusion; Fractional anisotropy; Recovery; Structural.

Figures

Fig. 1
Fig. 1
Lesion locations. Subcortical strokes are overlaid on axial MNI T1 slices (z-values in Montreal Neurological Institute (MNI) standard space). Brains with right-sided lesions were flipped over the mid-sagittal plane. Color bar indicates the number of subjects in which voxels are considered part of the lesion. UH unaffected hemisphere, LH lesioned hemisphere.
Fig. 2
Fig. 2
Trajectory variability maps for premotor–M1 connections in chronic stroke patients. Probable corticocortical connections between M1 and PMd, PMv and SMA are overlaid on T1 template in MNI standard space (upper row: axial slices with z-values, lower row: coronal slices with y-values). Color bar indicates the number of subjects in which voxels are considered part of the tracts of interest. Note that individual subject-specific binarized tracts of interest were used to calculate tract-related FA and not the group average (for illustration only). Tracts in subjects with right-sided lesions were flipped over the mid-sagittal plane. UH unaffected hemisphere, LH lesioned hemisphere.

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