Low-Frequency Oscillations Are a Biomarker of Injury and Recovery After Stroke

Jessica M Cassidy, Anirudh Wodeyar, Jennifer Wu, Kiranjot Kaur, Ashley K Masuda, Ramesh Srinivasan, Steven C Cramer, Jessica M Cassidy, Anirudh Wodeyar, Jennifer Wu, Kiranjot Kaur, Ashley K Masuda, Ramesh Srinivasan, Steven C Cramer

Abstract

Background and Purpose- Low-frequency oscillations reflect brain injury but also contribute to normal behaviors. We examined hypotheses relating electroencephalography measures, including low-frequency oscillations, to injury and motor recovery poststroke. Methods- Patients with stroke completed structural neuroimaging, a resting-state electroencephalography recording and clinical testing. A subset admitted to an inpatient rehabilitation facility also underwent serial electroencephalography recordings. The relationship that electroencephalography measures (power and coherence with leads overlying ipsilesional primary motor cortex [iM1]) had with injury and motor status was assessed, focusing on delta (1-3 Hz) and high-beta (20-30 Hz) bands. Results- Across all patients (n=62), larger infarct volume was related to higher delta band power in bilateral hemispheres and to higher delta band coherence between iM1 and bilateral regions. In chronic stroke, higher delta power bilaterally correlated with better motor status. In subacute stroke, higher delta coherence between iM1 and bilateral areas correlated with poorer motor status. These coherence findings were confirmed in serial recordings from 18 patients in an inpatient rehabilitation facility. Here, interhemispheric coherence between leads overlying iM1 and contralesional M1 was elevated at inpatient rehabilitation facility admission compared with healthy controls (n=22), declining to control levels over time. Decreases in interhemispheric coherence between iM1 and contralesional M1 correlated with better motor recovery. Conclusions- Delta band coherence with iM1 related to greater injury and poorer motor status subacutely, while delta band power related to greater injury and better motor status chronically. Low-frequency oscillations reflect both injury and recovery after stroke and may be useful biomarkers in stroke recovery and rehabilitation.

Keywords: brain; electroencephalography; functional neuroimaging; inpatients; motor cortex.

Figures

Figure 1.
Figure 1.
Infarct masks from the 62 patients overlaid on T1-weighted images. Brighter colors signify increasing voxel damage frequency. Bilateral injury (not shown) occurred in two patients.
Figure 2.
Figure 2.
Low frequency oscillations relate to stroke injury. Delta band power and coherence showed significant associations with infarct volume (A). Positive correlations between delta band power and injury occurred in both subacute and chronic stroke groups (B) while delta coherence with ipsilesional M1 positively correlated with injury in the subacute stroke group only (C). Colors reflect magnitude and direction of association at each EEG lead; color bar, Spearman’s rho. Black dots (C) indicate ipsilesional M1.
Figure 3.
Figure 3.
Low frequency oscillations relate to post-stroke motor status. Greater delta band power related to higher UEFM score (less impairment) in the chronic but not subacute phase (A), while greater delta band coherence with ipsilesional M1 related to lower UEFM score (more impairment) in the subacute but not chronic phase (B). Colors reflect magnitude and direction of association at each EEG lead; color bar, Spearman’s rho. Black dots (B) indicate ipsilesional M1.
Figure 4.
Figure 4.
(A) Greater gains in FIM-motor score from IRF admission to discharge correlated with larger decreases in delta band iM1-cM1 coherence (n=18). (B) Greater gains in UEFM scores from IRF admission to 90-days post-stroke correlated with decreased delta iM1-cM1 coherence (n=17).

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Source: PubMed

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