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      Respuesta eléctrica de la corteza contralateral al área de infarto en pacientes con enfermedad cerebrovascular isquémica Translated title: Electric response of the contralateral cortex to the myocardial infarction area in patients with ischemic cerebrovascular disease

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          Abstract

          Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo de 28 pacientes con enfermedad cerebrovascular isquémica, ingresados en el Servicio de Enfermedades Cerebrovasculares del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero hasta diciembre del 2011, con vistas a evaluar la respuesta eléctrica de la corteza cerebral contralateral al área de infarto y su papel en la recuperación motora de los afectados hemipléjicos por la lesión. La valoración de la actividad eléctrica se efectuó mediante el análisis cuantitativo del electroencefalograma digital y la de la recuperación funcional, por el índice de Barthel. En la serie la edad media fue de 67,2 años ± 2, predominó el sexo masculino y todos los pacientes presentaron alteración de la actividad eléctrica cortical, de los cuales, 39,3 % la manifestaba en el hemisferio contralateral al área de infarto, con una peor recuperación motora a los 6 meses de evolución. Por último, la afectación eléctrica de la corteza cerebral contralateral al área de infarto constituye una manifestación observada frecuentemente en pacientes con enfermedades cerebrovasculares isquémicas, lo que influye de manera negativa en su recuperación motora

          Translated abstract

          An observational, descriptive, longitudinal and prospective study of 28 patients with ischemic cerebrovascular disease, admitted in the Cerebrovascular Diseases Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from January to December, 2011, with the objective of evaluating the electric response from the contralateral cerebral cortex to the myocardial infarction area and its role in the motor recovery of the affected hemiplegic patients. The evaluation of the electric activity was made by means of the quantitative analysis of the digital electroencephalogram, and that of the functional recovery through the Barthel index. In the series the mean age was of 67.2 years ± 2, the male sex prevailed and all the patients presented changes of the electrical cortical activity, of which, 39.3% manifested it in the contralateral hemisphere to the myocardial infarction area, with a worse motor recovery after 6 months of the clinical course. Lastly, the electric damage of the contralateral cerebral cortex to the myocardial infarction area constitutes a frequently observed manifestation in patients with ischemic cerebrovascular diseases, what influences in a negative way in their motor recovery

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          Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery.

          Stroke remains a leading cause of adult disability. Some degree of spontaneous behavioral recovery is usually seen in the weeks after stroke onset. Variability in recovery is substantial across human patients. Some principles have emerged; for example, recovery occurs slowest in those destined to have less successful outcomes. Animal studies have extended these observations, providing insight into a broad range of underlying molecular and physiological events. Brain mapping studies in human patients have provided observations at the systems level that often parallel findings in animals. In general, the best outcomes are associated with the greatest return toward the normal state of brain functional organization. Reorganization of surviving central nervous system elements supports behavioral recovery, for example, through changes in interhemispheric lateralization, activity of association cortices linked to injured zones, and organization of cortical representational maps. A number of factors influence events supporting stroke recovery, such as demographics, behavioral experience, and perhaps genetics. Such measures gain importance when viewed as covariates in therapeutic trials of restorative agents that target stroke recovery.
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            Dynamical consequences of lesions in cortical networks.

            To understand the effects of a cortical lesion it is necessary to consider not only the loss of local neural function, but also the lesion-induced changes in the larger network of endogenous oscillatory interactions in the brain. To investigate how network embedding influences a region's functional role, and the consequences of its being damaged, we implement two models of oscillatory cortical interactions, both of which inherit their coupling architecture from the available anatomical connection data for macaque cerebral cortex. In the first model, node dynamics are governed by Kuramoto phase oscillator equations, and we investigate the sequence in which areas entrain one another in the transition to global synchrony. In the second model, node dynamics are governed by a more realistic neural mass model, and we assess long-run inter-regional interactions using a measure of directed information flow. Highly connected parietal and frontal areas are found to synchronize most rapidly, more so than equally highly connected visual and somatosensory areas, and this difference can be explained in terms of the network's clustered architecture. For both models, lesion effects extend beyond the immediate neighbors of the lesioned site, and the amplitude and dispersal of nonlocal effects are again influenced by cluster patterns in the network. Although the consequences of in vivo lesions will always depend on circuitry local to the damaged site, we conclude that lesions of parietal regions (especially areas 5 and 7a) and frontal regions (especially areas 46 and FEF) have the greatest potential to disrupt the integrative aspects of neocortical function. (c) 2008 Wiley-Liss, Inc.
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              The role of the contralesional motor cortex for motor recovery in the early days after stroke assessed with longitudinal FMRI.

              Stroke may trigger a number of cellular and molecular events in perilesional and remote brain regions enabling cortical reorganization and recovery of function. We here investigated the pattern and time course of acute stroke-induced changes in motor system activity during motor recovery using functional magnetic resonance imaging. Hand movement-related neural activity was assessed in 11 acute stroke patients scanned 3 times during the first 2 weeks starting within 72 h after symptom onset. A motor recovery score was computed based on the action research arm test and the maximum grip force. Increases of activity in primary motor cortex, premotor cortex (dorsal and ventral), and supplementary motor area in both hemispheres significantly correlated with behavioral recovery. These longitudinal changes depended upon the degree of initial motor impairment: Patients with mild deficits did not differ from healthy subjects. In contrast, patients with severe deficits were characterized by a global reduction of task-related activity, followed by increases in ipsilesional as well as contralesional motor areas. The finding that the gradually increasing activity in contralesional primary motor and premotor cortex correlated with improved functional recovery in severely affected patients indicates early cortical reorganization supporting motor function of the affected hand.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                san
                MEDISAN
                MEDISAN
                Centro Provincial de Ciencias Médicas, Santiago de Cuba (Santiago de Cuba )
                1029-3019
                December 2014
                : 18
                : 12
                : 1701-1709
                Affiliations
                [1 ] Hospital General Docente Dr. Juan Bruno Zayas Alfonso Cuba
                [2 ] Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres Cuba
                Article
                S1029-30192014001200010
                81a08776-3b7b-4a4e-82a4-ea216c74a627

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=1029-3019&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Servicio de Enfermedades Cerebrovasculares,ischemic cerebrovascular disease,cerebral infarction,motor recovery,hemiplegia,electrical cortical activity,Cerebrovascular Diseases Service,enfermedad cerebrovascular isquémica,infarto cerebral,recuperación motora,hemiplejia,actividad eléctrica cortical

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