1. Severity-Dependent Interhemispheric White Matter Connectivity Predicts Poststroke Neglect Recovery.
- Author
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Kaufmann BC, Pastore-Wapp M, Bartolomeo P, Geiser N, Nyffeler T, and Cazzoli D
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Functional Laterality physiology, Prospective Studies, Severity of Illness Index, Neural Pathways physiopathology, Neural Pathways diagnostic imaging, Neural Pathways pathology, Aged, 80 and over, Perceptual Disorders etiology, Perceptual Disorders physiopathology, Perceptual Disorders rehabilitation, Stroke complications, Stroke diagnostic imaging, Stroke physiopathology, White Matter diagnostic imaging, White Matter pathology, Recovery of Function physiology, Diffusion Tensor Imaging
- Abstract
Left-sided spatial neglect is a very common and challenging issue after right-hemispheric stroke, which strongly and negatively affects daily living behavior and recovery of stroke survivors. The mechanisms underlying recovery of spatial neglect remain controversial, particularly regarding the involvement of the intact, contralesional hemisphere, with potential contributions ranging from maladaptive to compensatory. In the present prospective, observational study, we assessed neglect severity in 54 right-hemispheric stroke patients (32 male; 22 female) at admission to and discharge from inpatient neurorehabilitation. We demonstrate that the interaction of initial neglect severity and spared white matter (dis)connectivity resulting from individual lesions (as assessed by diffusion tensor imaging, DTI) explains a significant portion of the variability of poststroke neglect recovery. In mildly impaired patients, spared structural connectivity within the lesioned hemisphere is sufficient to attain good recovery. Conversely, in patients with severe impairment, successful recovery critically depends on structural connectivity within the intact hemisphere and between hemispheres. These distinct patterns, mediated by their respective white matter connections, may help to reconcile the dichotomous perspectives regarding the role of the contralesional hemisphere as exclusively compensatory or not. Instead, they suggest a unified viewpoint wherein the contralesional hemisphere can - but must not necessarily - assume a compensatory role. This would depend on initial impairment severity and on the available, spared structural connectivity. In the future, our findings could serve as a prognostic biomarker for neglect recovery and guide patient-tailored therapeutic approaches., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)
- Published
- 2024
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