Longitudinal study of diffusion tensor imaging properties of affected cortical spinal tracts in acute and chronic hemorrhagic stroke

This study investigated the clinical value of diffusion tensor imaging (DTI) in predicting the motor outcome in patients with basal ganglia hemorrhage. This prospective study included 23 patients assessed with DTI to measure the fractional anisotropy (FA) value in affected cortical spinal tract (CST) at three time points: day 0, day 30 and day 90 after onset. The motor function score (MFS) was applied to evaluate motor function and patients were divided into good and poor outcome groups according to the MFS on day 90. The mean FA value on day 0 was significantly lower in the poor outcome group than in the good outcome group (p < 0.01). FA value gradually decreased in the poor outcome group until day 90 after onset, while it continuously increased in the good outcome group. The MFS obtained at day 90 after onset was significantly correlated with the initial FA value in the affected cerebral peduncle (r = −0.926, p < 0.01). Receiver operating characteristic curve analysis showed that the FA value on day 0 could predict motor function outcome with a sensitivity of 88.89% and specificity of 92.86% at the initial FA value of 0.45. The FA value of affected CST in acute cerebral hemorrhage may valuably predict the motor function outcome and its dynamic change may represent the Wallerian degeneration in motor tracts after hemorrhagic stroke.     

Effects of ceftriaxone on ischemia/reperfusion injury in rat brain

The aim of this study was to investigate the effect of ceftriaxone treatment against short-term global brain ischemia/reperfusion (I/R) injury in rats. The study was carried out on 30 Wistar-albino rats that were divided into three groups: control group (n = 10), I/R group (n = 10) and I/R-ceftriaxone group (n = 10). Malondialdehyde (MDA) levels were significantly increased in the I/R group in comparison with the control group (p < 0.001). MDA was significantly lower in the I/R-ceftriaxone group than in the I/R group (p < 0.05). Superoxide dismutase activity was significantly decreased in the I/R group and increased in the I/R-ceftriaxone group as compared with the control group. Glutathione peroxidase activity was significantly decreased in the I/R group and increased in the I/R-ceftriaxone group as compared with the I/R group and the control. Histopathologically, ceftriaxone provided morphological improvement compared with the I/R group. We concluded that ceftriaxone has neuron-protective effects due to its antioxidant properties as shown by a decrease in MDA overproduction and histological improvement in brain tissue.     

Differential effect of Taekwondo training on knee muscle strength and reactive and static balance control in children with developmental coordination disorder: A randomized controlled trial

This randomized controlled trial aimed to investigate the effect of short-term intensive TKD training on the isokinetic knee muscle strength and reactive and static balance control of children with developmental coordination disorder (DCD). Among the 44 children with DCD (mean age: 7.6 ± 1.3 years) recruited, 21 were randomly assigned to undergo daily TKD training for 1 h over three consecutive months, with the remaining 23 children being assigned to the DCD control group. Eighteen typically developing children (mean age: 7.2 ± 1.0 years) received no training as normal controls. Knee extensor and flexor muscle strength and reactive and static balance control were assessed using an isokinetic machine (with low, moderate and high movement velocities), a motor control test (MCT) and a unilateral stance test (UST), respectively. A repeated measures MANCOVA revealed a significant group through time interaction effect in isokinetic outcomes at 180°/s and in the UST outcome. Post hoc analysis demonstrated that DCD-TKD children's isokinetic knee muscle strength, specifically at 180°/s, was as high as that of the normal control children (p > 0.0083) after TKD training. Moreover, UST body sway velocity was slower in the DCD-TKD group than in the DCD control group (p < 0.001), and was comparable to that of the normal control group (p > 0.05) after TKD training. However, no such improvement in balance was observed in the MCT (p > 0.025). The results show that children with DCD who undergo a 3-month program of intensive TKD training experience improvements in isokinetic knee muscle strength at 180°/s and static single-leg standing balance control, but do not benefit from improved reactive balance control.     

Ectonucleotidase and acetylcholinesterase activities in synaptosomes from the cerebral cortex of streptozotocin-induced diabetic rats and treated with resveratrol

The aim of the present study was to investigate the effects of resveratrol (RV), an important neuroprotective compound on NTPDase, 5′-nucleotidase and acetylcholinesterase (AChE) activities in cerebral cortex synaptosomes of streptozotocin (STZ)-induced diabetic rats. The animals were divided into six groups (n = 8): control/saline; control/RV 10 mg/kg; control/RV 20 mg/kg; diabetic/saline; diabetic/RV 10 mg/kg; diabetic/RV 20 mg/kg. After 30 days of treatment with resveratrol the animals were sacrificed and the cerebral cortex was removed for synaptosomes preparation and enzymatic assays. The results demonstrated that NTPDase and 5′-nucleotidase activities were significantly increased in the diabetic/saline group (p < 0.05) compared to control/saline group. Treatment with resveratrol significantly increased NTPDase, 5′-nucleotidase activities in the diabetic/RV10 and diabetic/RV20 groups (p < 0.05) compared to diabetic/saline group. When resveratrol was administered per se there was also an increase in the activities of these enzymes in the control/RV10 and control/RV20 groups (p < 0.05) compared to control/saline group. AChE activity was significantly increased in the diabetic/saline group (p < 0.05) compared to control/saline group. The treatment with resveratrol prevented this increase in the diabetic/RV10 and diabetic/RV20 groups. In conclusion, this study demonstrated that the resveratrol interfere with the purinergic and cholinergic neurotransmission by altering NTPDase, 5′-nucleotidase and AChE activities in cerebral cortex synaptosomes of diabetic rats. In this context, we can suggest that resveratrol should be considered potential therapeutics and scientific tools to be investigated in brain disorders associated with the diabetes.     

Functional repetitive transcranial magnetic stimulation increases motor cortex excitability in survivors of stroke

ObjectiveTo determine if repetitive transcranial magnetic stimulation (rTMS) applied to the motor cortex with simultaneous voluntary muscle activation, termed functional-rTMS, will promote greater neuronal excitability changes and neural plasticity than passive-rTMS in survivors of stroke.MethodsEighteen stroke survivors were randomized into functional-rTMS (EMG-triggered rTMS) or passive-rTMS (rTMS only; control) conditions. Measures of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), force steadiness (coefficient of variation, CV) at 10% of maximum voluntary contraction, and pinch task muscle activity were assessed before and after rTMS. Functional-rTMS required subjects to exceed a muscle activation threshold to trigger each rTMS train; the passive-rTMS group received rTMS while relaxed.ResultsSignificant interactions (time × condition) were observed in abductor pollicis brevis (APB) SICI, APB ICF, CV of force, and APB muscle activity. Functional-rTMS decreased APB SICI (p < 0.05) and increased ICF (p < 0.05) after stimulation, whereas passive-rTMS decreased APB muscle activity (p < 0.01) and decreased CV of force (p < 0.05). No changes were observed in FDI measures (EMG, ICF, SICI).Conclusion(s)Functional-rTMS increased motor cortex excitability, i.e., less SICI and more ICF for the APB muscle. Passive stimulation significantly reduced APB muscle activity and improved steadiness.SignificanceFunctional-rTMS promoted greater excitability changes and selectively modulated agonist muscle activity.     

Treadmill walking effects on grip strength in young men with Down syndrome

This study was aimed at investigating the relation between grip strength and anthropometric factors and the impact of an aerobic exercise on grip strength in young men with Down syndrome (DS). This study was a pre-post design. Twelve males with DS were assigned to an exercise group, who walked using an incremental protocol on a treadmill for 20 min at aerobic levels. Eight additional persons with DS were assigned to an attentional control group, who watched a video. Measure of grip strength was tested pre- and post-interventions. The results showed positively significant relationship among grip strength and age (r = .74, p < .01), weight (r = .52, p = .02), body mass index (r = .61, p = .01) and waist circumference (r = .54, p = .02). In addition, Grip strength was slightly improved after exercise (p = .03) but decreased after control condition. The results showed that anthropometric factors, such as age, weight, body mass index and waist circumference, were positively correlated with grip strength in young men with DS. Further, improvement in grip strength can be found even after a single exercise session. This finding emphasizes the importance of maintaining an active lifestyle in persons with DS for performing activities of daily living.     

Association between executive/attentional functions and caries in children with cerebral palsy

The aim of the present study was to evaluate the existence of an association between attention/executive functions and the development of dental caries in individuals with cerebral palsy (CP). Seventy-six children with CP were selected from a physical rehabilitation center and a school serving children with disabilities. The control group was made up of 89 children without neurological impairment. Socioeconomic status, presence of teeth with cavities due to caries, degree of motor impairment and intellectual, executive and attentional functions were assessed. Mean age of participants was 8.9 years (SD = 3.56). The CP group had a significantly lower performance (p < 0.05, Mann–Whitney test) on the intelligence, attentional function and executive function tests in comparison to the control group. Controlling for the clinical diagnosis (CP or control group), motor impairment and intellectual function, the significant explanatory variables for the presence of teeth with cavities were performance on the Complex Rey figure test (OR = 0.941) and the Digit Span subtest of the Wechsler Intelligence Scale for Children in backward order (OR = 0.581). After controlling for intellectual function, clinical diagnosis and motor impairment, deficits in executive and attentional functions increased the odds of developing dental caries in children with cerebral palsy.     

Supplementation of folic acid and vitamin B12 reduces plasma levels of asymmetric dimethylarginine in patients with acute ischemic stroke

Increased levels of asymmetric dimethylarginine (ADMA) have been observed in patients with acute ischemic stroke. We aimed to investigate the correlation between ADMA and ischemic stroke, and evaluate the effect of supplementation of folic acid and vitamin B₁₂ on concentrations of ADMA. Patients were randomized into intervention and non-intervention groups within 3 days after symptom onset. Intervention group patients were treated with folic acid (5 mg daily) and vitamin B₁₂ (500 μg twice daily) for 12 weeks. ADMA and homocysteine (Hcy) concentrations were measured before treatment (baseline) and 2 and 12 weeks after treatment. The laboratory measures were also collected from healthy controls. Eighty five subjects were enrolled in this study, from whom 72 with complete baseline and follow-up laboratory data were included in the present analysis. Thirty four patients were assigned to the intervention group and 38 patients to the non-intervention group. Sixty people were enrolled as healthy controls. Levels of ADMA and Hcy were raised (p < 0.05) in patients with acute ischemic stroke. With supplementation of both folic acid and vitamin B₁₂, the levels of ADMA and Hcy decreased significantly at 2 and 12 weeks (p < 0.05). The present study reconfirmed that ADMA can be regarded as a risk biomarker for acute ischemic stroke. We observed that with supplementation of folic acid and vitamin B_12, levels of ADMA were decreased in patients with acute ischemic stroke.     

Does somatosensory discrimination activate different brain areas in children with unilateral cerebral palsy compared to typically developing children? An fMRI study

Aside from motor impairment, many children with unilateral cerebral palsy (CP) experience altered tactile, proprioceptive, and kinesthetic awareness. Sensory deficits are addressed in rehabilitation programs, which include somatosensory discrimination exercises. In contrast to adult stroke patients, data on brain activation, occurring during somatosensory discrimination exercises, are lacking in CP children. Therefore, this study investigated brain activation with functional magnetic resonance imaging (fMRI) during passively guided somatosensory discrimination exercises in 18 typically developing children (TD) (age, M = 14 ± 1.92 years; 11 girls) and 16 CP children (age, M = 15 ± 2.54 years; 8 girls). The demographic variables between both groups were not statistically different. An fMRI compatible robot guided the right index finger and performed pairs of unfamiliar geometric shapes in the air, which were judged on their equality. The control condition comprised discrimination of music fragments. Both groups exhibited significant activation (FDR, p < .05) in frontoparietal, temporal, cerebellar areas, and insula, similar to studies in adults. The frontal areas encompassed ventral premotor areas, left postcentral gyrus, and precentral gyrus; additional supplementary motor area (SMA_proper) activation in TD; as well as dorsal premotor, and parietal operculum recruitment in CP. On uncorrected level, p < .001, TD children revealed more left frontal lobe, and right cerebellum activation, compared to CP children. Conversely, CP children activated the left dorsal cingulate gyrus to a greater extent than TD children. These data provide incentives to investigate the effect of somatosensory discrimination during rehabilitation in CP, on clinical outcome and brain plasticity.     

Psychometric properties of the DCDDaily-Q: A new parental questionnaire on children's performance in activities of daily living

Difficulties in the performance of activities of daily living (ADL) are a key feature of developmental coordination disorder (DCD). The DCDDaily-Q was developed to address children's motor performance in a comprehensive range ADL. The aim of this study was to investigate the psychometric properties of this parental questionnaire. Parents of 218 five to eight year-old children (DCD group: N = 25; reference group: N = 193) completed the research version of the new DCDDaily-Q and the Movement Assessment Battery for Children-2 (MABC2) Checklist and Developmental Coordination Disorder Questionnaire (DCDQ). Children were assessed with the MABC2 and DCDDaily. Item reduction analyses were performed and reliability (internal consistency and factor structure) and concurrent, discriminant, and incremental validity of the DCDDaily-Q were investigated. The final version of the DCDDaily-Q comprises 23 items that cover three underlying factors and shows good internal consistency (Cronbach's α > .80). Moderate correlations were found between the DCDDaily-Q and the other instruments used (p < .001 for the reference group; p > .05 for the DCD group). Discriminant validity of the DCDDaily-Q was good for DCDDaily-Q total scores (p < .001) and all 23 item scores (p < .01), indicating poorer performance in the DCD group. Sensitivity (88%) and specificity (92%) were good. The DCDDaily-Q better predicted DCD than currently used questionnaires (R² = .88). In conclusion, the DCDDaily-Q is a valid and reliable questionnaire to address children's ADL performance.     

Sensorimotor function in preschool-aged children with expressive language disorder

AimThe aim of the study was to evaluate functional motor performance and haptic object recognition in 5-year-old children with mild expressive language disorder (ELD) in comparison with age- and gender-matched healthy children.MethodsThe subjects were classified by speech-language pathologist using The Reynell Developmental Language Scales III and Boehm Test of Basic Concepts: Preschool as children with mild ELD (n = 29, incl. 23 boys and 6 girls) and children with typical language development as controls (n = 29, incl. 23 boys and 6 girls). The children were examined for manual dexterity, ball skills, static and dynamic balance by Movement-ABC, haptic object recognition (HOR), hand-grip strength (HGS) and vertical jumping performance.ResultsChildren with mild ELD demonstrated significantly higher scores (i.e., inferior performance) in all subtests of M-ABC (all p values <0.05), in haptic object recognition (p < 0.01) and vertical jumping height (p < 0.05) compared to controls. However, no statistically significant differences (p > 0.05) emerged from HGS. Boys with mild ELD demonstrated higher results in impairment score (p < 0.001), ball skills (p < 0.01) and balance (p < 0.01) of M-ABC, as well as in HOR (p < 0.05). Girls with mild ELD showed higher impairment score (p < 0.05) with lower percentile (p < 0.05) in M-ABC, indicating inferior motor performance, and lower HGS for the non-dominant hand (p < 0.05). Seven out of 29 (24.1%) children with mild ELD had definite or borderline motor difficulties, while only one child in control group (3.4%) demonstrated borderline motor difficulties.ConclusionsChildren with mild expressive language disorder do not perform as well as controls in tests of functional motor skills, but their results in tests demanding maximal muscle force generation are in level with typically developing children. Boys and girls with mild ELD demonstrated higher impairment scores in M-ABC, indicating the need to follow their overall development more closely.     

Lack of differential motor outcome with subthalamic nucleus region stimulation in Parkinson’s disease

Deep brain stimulation (DBS) has emerged as a viable therapy for Parkinson’s disease (PD). The impact of subthalamic nucleus (STN) lead placement (lateral versus medial) on motor outcome, however, has not been systematically evaluated. Forty-eight patients with PD underwent STN-DBS surgery and were evaluated postoperatively for 48 weeks for motor improvement as measured by the Unified Parkinson’s Disease Rating Scale (UPDRS) part III (standardized motor examination) and levodopa equivalent daily dose (LEDD). Postoperative MRI was used to identify the location of the active stimulating contact and motor outcome was analyzed. STN-DBS was associated with significant improvement in motor outcome as determined by a reduction in the UPDRS part III subscore from 34.44 ± 1.29 at baseline to 18.76 ± 1.06 at end visit (p < 0.0001) and a reduction in LEDD from 1721 ± 152 mg/day at baseline to 1134 ± 119 mg/day at end visit (p = 0.0024). Patients with stimulating contacts in the medial STN compared to the lateral STN did not demonstrate any significant differences in motor outcome (UPDRS, p = 0.5811; LEDD, p = 0.7341). No significant differences were found in motor outcome between patients with STN stimulation compared to stimulation of surrounding fiber tracts (p = 0.80). No significant difference in stimulation voltage was noted with respect to lead location. Our study did not find a significant effect for the location of active contact and motor outcome neither within the subregions of the STN nor between the STN and surrounding fibers. Further research is needed to better understand the neurophysiological basis for these results.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Evaluation of developmental profiles of children with hydrocephalus

ObjectiveThe objective of this study was to compare the developmental characteristics of children with hydrocephalus with those of healthy children.Material and methodsA total of 109 children aged between 2 and 46 months were included in the study, 54 patients diagnosed with hydrocephalus and 55 healthy children were evaluated with demographic data forms and Denver Developmental Screening Test II.ResultsThe mean personal–social (p < 0.001), fine motor-adaptive (p < 0.001), language (p < 0.001), and gross motor subscale scores were significantly lower in children with hydrocephalus than in the control group. Personal–social (p = 0.002) and gross motor (p = 0.029) subscale scores were significantly lower in children with obstructive hydrocephalus than communicating hydrocephalus. There was a significant negative correlation between language scores and ages of the children with hydrocephalus (r = ?0.350, p = 0.009). It was found that children with obstructive hydrocephalus carry a 6.7 folds higher risk of experiencing problems in terms of personal–social development compared to those with communicating hydrocephalus (p = 0.011).ConclusionWe found that patients with hydrocephalus were developmentally retarded compared to the healthy control subjects. Retardation was the most prominent in the obstructive group. Our results showed that neurodevelopmental follow-up should be carried-out regularly in pediatric patients with hydrocephalus, and early intervention should be started in necessary cases.     

Effects of overweight and obese body mass on motor planning and motor skills during obstacle crossing in children

Little is known about how obesity relates to motor planning and skills during functional tasks. We collected 3-D kinematics and kinetics as normal weight (n = 10) and overweight/obese (n = 12) children walked on flat ground and as they crossed low, medium, and high obstacles. We investigated if motor planning and motor skill impairments were evident during obstacle crossing. Baseline conditions showed no group differences (all ps > .05). Increased toe clearance was found on low obstacles (p = .01) for the overweight/obese group and on high obstacles (p = .01) for the normal weight group. With the crossing leg, the overweight/obese group had larger hip abduction angles (p = .01) and medial ground reaction forces (p = .006) on high obstacles and high anterior ground reaction forces on low obstacles (p = .001). With the trailing leg, overweight/obese children had higher vertical ground reaction forces on high obstacles (p = .005) and higher knee angles (p = .01) and anterior acceleration in the center of mass (p = .01) on low obstacles. These findings suggest that differences in motor planning and skills in overweight/obese children may be more apparent during functional activities.     

Individuals with intellectual disability have lower voluntary muscle activation level

The aim of this study was to explore the voluntary activation level during maximal voluntary contraction (MVC) in individuals with intellectual disability (ID) versus individuals without ID using the twitch interpolation technique. Ten individuals with mild ID (ID group) and 10 sedentary men without ID (control group) participated in this study. The evaluation of neuromuscular function consisted in three brief MVCs (3 s) of the knee extension superimposed with electrical nerve stimulation (NES) to measure voluntary activation. Muscle activity levels were also measured with surface EMG. The root mean square (RMS) was extracted from the EMG signal. The RMS/Mmax ratio and the neuromuscular efficiency (NME) were calculated. Our results reported that individuals with ID present lower muscle strength (p < 0.001), lower voluntary activation level (p < 0.001), lower RMS values of vastus lateralis (p < 0.05), vastus medialis (p < 0.05), and rectus femoris (p < 0.001) muscles. In addition, our results showed lower RMS/Mmax values in the ID group than in the control group for the VM (0.05 ± 0.01 mV vs. 0.04 ± 0.01 mV; p < 0.05) and the RF (0.06 ± 0.02 mV vs. 0.05 ± 0.02 mV; p < 0.05) muscles. However, no significant difference was reported for the VL muscle (0.05 ± 0.02 mV vs. 0.05 ± 0.02 mV; p = 0.463). Moreover, Individuals with ID present smaller potentiated twitch (p < 0.001). However, no significant difference was reported in the NME ratio. These results suggest that the lower muscle strength known in individuals with ID is related to a central nervous system failure to activate motor units and to some abnormal intrinsic muscle properties. It seems that the inactive lifestyle adopted by individuals with ID is one of the most important factors of their lower voluntary activation levels. Therefore, physical activities should be introduced in life style of individuals with ID to improve their neuromuscular function.     

Is severity of motor coordination difficulties related to co-morbidity in children at risk for developmental coordination disorder?

Aim of the study was to investigate whether 7–9 year old children with severe motor difficulties are more at risk of additional difficulties in activities in daily living, academic skills, attention and social skills than children with moderate motor difficulties. Children (N = 6959) from a population based cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC), were divided into three groups based on their scores on the ALSPAC Coordination Test at age 7: control children (scores above 15th centile; N = 5719 [82.1%]); children with moderate (between 5th and 15th centile; N = 951 [13.7%]); and children with severe motor difficulties (below 5th centile N = 289 [4.2%]). Children with neurological disorders or an IQ < 70 were excluded. Logistic regression was used to compare children with moderate and severe motor coordination difficulties with each other and with control children regarding their risk of co-morbidity defined as significant (<10th centile) difficulties with activities of daily living (ADL); academic skills (reading, spelling and handwriting); attention; social skills (social cognition and nonverbal skills). Children with severe motor difficulties demonstrated a higher risk of difficulties in ADL, handwriting, attention, reading, and social cognition than children with moderate motor difficulties, who in turn had a higher risk of difficulties than control children in five out of seven domains. Screening and intervention of co-morbid problems is recommended for children with both moderate and severe motor difficulties.     

Health related quality of life in parents of six to eight year old children with Down syndrome

Raising a child with Down syndrome (DS) has been found to be associated with lowered health related quality of life (HRQoL) in the domains cognitive functioning, social functioning, daily activities and vitality. We aimed to explore which socio-demographics, child functioning and psychosocial variables were related to these HRQoL domains in parents of children with DS. Parents of 98 children with DS completed the TNO-AZL adult quality of life questionnaire (TAAQOL) and a questionnaire assessing socio-demographic, child functioning and psychosocial predictors. Using multiple linear regression analyses for each category of predictors, we selected relevant predictors for the final models. The final multiple linear regression models revealed that cognitive functioning was best predicted by the sleep of the child (β = .29, p < .01) and by the parent having given up a hobby (β = ?.29, p < .01), social functioning by the quality of the partner relation (β = .34, p < .001), daily activities by the parent having to care for an ill friend or family member (β = ?.31, p < .01), and vitality by the parent having enough personal time (β = .32, p < .01). Overall, psychosocial variables rather than socio-demographics or child functioning showed most consistent and powerful relations to the HRQoL domains of cognitive functioning, social functioning, daily activities and vitality. These psychosocial variables mainly related to social support and time pressure. Systematic screening of parents to detect problems timely, and interventions targeting the supportive network and the demands in time are recommended.     

Serum indoleamine 2,3-dioxygenase and kynurenine aminotransferase enzyme activity in patients with ischemic stroke

We investigated the activation and pathophysiological roles of indoleamine 2,3-dioxygenase (IDO) and kynurenine aminotransferase (KAT) in patients with ischemic stroke. Patients were recruited from the acute stroke unit of a general hospital within 24 hours post-stroke. The immune transmission turbidity method was used to determine the concentration of serum high-sensitivity C-reactive protein (hsCRP), apolipoprotein A-1 and apolipoprotein B. The concentrations of triglyceride, cholesterol, high density lipoprotein (HDL), low density lipoprotein and non-esterified fatty acids were determined using an enzymatic method. Tryptophan (TRP), kynurenine (KYN) and kynurenine acid (KYNA) concentrations were determined by high performance liquid chromatography. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological deficits at admission and 3 weeks post-stroke. The IDO and KAT activity ratio were calculated by KYN/TRP and KYNA/KYN, respectively. The correlation between hsCRP and IDO, KAT and NIHSS score was also analyzed. A total of 81 patients with ischemic stroke and 35 normal controls were recruited. Lower TRP, KYNA, HDL and KAT activity ratio were found in the stroke group compared to the control group (p < 0.05). The levels of hsCRP and IDO activity ratio were much higher in the stroke group than the control group (p < 0.01). The IDO activity in patients with ischemic stroke showed a positive correlation with hsCRP (r = 0.425, p = 0.027). In addition, hsCRP and IDO levels were positively associated with the NIHSS score both at admission and 3 weeks post-stroke. These data suggest an inflammatory response characterized by up-regulated IDO activation in ischemic stroke, which might be closely relevant to its pathophysiology.     

Modulation of interhemispheric activation balance in motor-related areas of stroke patients with motor recovery: Systematic review and meta-analysis of fMRI studies

BackgroundFunctional magnetic resonance imaging (fMRI) studies suggest that stroke-induced motor deficits are associated with an interhemispheric imbalance of motor activation. This meta-analysis aims to determine the changes of interhemispheric activation balance (IHAB) in motor-related cortices along with post-stroke motor recovery.MethodsWe searched PubMed for fMRI studies that investigated IHAB in stroke patients with motor recovery. Laterality indexes (LIs, (ipsilesional activation − contralesional activation)/(ipsilesional activation + contralesional activation)) before and after motor improvement were extracted as the outcome measures of IHAB. Data were synthesized by calculating standardized mean difference (SMD, Hedges’ adjusted g) with 95% confidence intervals (CI).ResultsAfter the rejection of 459 studies, 22 trials fulfilled the inclusion criteria and were included in the systematic review and meta-analysis. The LIs of sensorimotor cortex (SMC, 22 trials, 195 subjects), premotor cortex (PMC, 12 trials, 93 subjects), supplementary motor area (SMA, 12 trials, 92 subjects), and cerebellum (CB, 4 trials, 31 subjects) were assessed. Studies sampling from stroke patients with motor improvement showed positive changes of LI in SMC (SMD, 0.71; 95% CI, 0.41–1.01; P < 0.00001) and PMC (SMD, 0.68; 95% CI, 0.36–1.00; P < 0.0001), but not in SMA (SMD, 0.07; 95% CI, −0.62 to 0.75; P = 0.85) and CB (SMD, −0.17; 95% CI, −1.52 to 1.19, P = 0.81). Studies involving stroke patients with poor motor recovery showed non-significant changes in all of the four motor-related cortices (P > 0.05).ConclusionsThis meta-analysis suggests that along with good motor recovery of stroke patients, the IHAB is up-regulated in SMC and PMC, but not significantly changed in SMA and CB. Because of the limited data, further studies are needed to verify the findings.