The Role of Ascending Ventral‐Tegmental Fibers for Recovery after Stroke

Autor: Jonas A. Hosp, Andrea Dressing, Anika Engesser, Volkmar Glauche, Dorothee Kümmerer, Ema B. Vaidelyte, Mariachristina Musso, Michel Rijntjes, Cornelius Weiller
Rok vydání: 2023
Předmět:
Zdroj: Annals of Neurology. 93:922-933
ISSN: 1531-8249
0364-5134
DOI: 10.1002/ana.26595
Popis: The integrity of cortical motor networks and their descending effector-pathway (the corticospinal tract; CST) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to motor cortex (the VTMC-tract) for post-stroke recovery.Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC-tract and CST were obtained from 133 patients (63.9±13.4 years, 45 female) during acute and chronic stage after first-ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC-tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale [NIHSS] with motor and cortical-symptom subscores; modified Fugl-Meyer upper extremity score [mFMMS]; modified Ranking Scale [mRS]).A significant post-stroke degeneration occurred in both tracts, but only VTMC-degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC-tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (mFMMS) and cortical symptoms (aphasia, neglect) captured by NIHSS compared to CST. Changes in CST-integrity merely were associated with the degree of hemiparesis (NIHSS motor subscale).Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favourable outcome regarding independence (mRS), upper limb motor function (mFMMS) and cortical symptoms (aphasia, neglect) was stronger related to the ascending than descending tract. This article is protected by copyright. All rights reserved.
Databáze: OpenAIRE
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