Association that Neuroimaging and Clinical Measures Have with Change in Arm Impairment in a Phase 3 Stroke Recovery Trial

作者：Anne Schwarz, Marc D. Feldman, Vu Le, Jesse Dawson, Charles Y. Liu, Gerard E. Francisco, Steven L. Wolf, Anand Dixit, Jen Alexander, Rushna Ali, Benjamin L. Brown, Wuwei Feng, Lou DeMark, Leigh R. Hochberg, Steven A. Kautz, Arshad Majid, Michael W. O’Dell, Jessica Redgrave, Duncan L. Turner, Teresa J. Kimberley, Steven C. Cramer · 发表于：Annals of Neurology · 年份：2024 · DOI：10.1002/ana.27156 · 被引用次数：3 · 研究领域：Vagus Nerve Stimulation Research、Botulinum Toxin and Related Neurological Disorders、Nerve injury and regeneration

OBJECTIVE: Vagus nerve stimulation (VNS) paired with rehabilitation therapy improved motor status compared to rehabilitation alone in the phase III VNS-REHAB stroke trial, but treatment response was variable and not associated with any clinical measures acquired at baseline, such as age or side of paresis. We hypothesized that neuroimaging measures would be associated with treatment-related gains, examining performance of regional injury measures versus global brain health measures in parallel with clinical measures. METHODS: Baseline magnetic resonance imaging (MRI) scans in the VNS-REHAB trial were used to derive regional injury measures (extent of injury to corticospinal tract, the primary regional measure; plus extent of injury to precentral gyrus and postcentral gyrus; lesion volume; and lesion topography) and global brain health measures (degree of white matter hyperintensities, the primary global brain measure; plus volumes of cerebrospinal fluid, cortical gray matter, white matter, each thalamus, and total brain). Eight clinical measures assessed at baseline were also evaluated (treatment group, age, race, gender, paretic side, pre-stroke dominant hand, time since stroke, and baseline Fugl-Meyer upper extremity score). Bivariate analyses compared each measure with the primary trial end point (change in Fugl-Meyer upper extremity score from baseline to end of 6 weeks of treatment) across all subjects, with secondary analyses examining trial groups separately. RESULTS: ...