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Functional correlates with left-right asymmetry of visual evoked potentials in stroke patients: modeling and
Objective:
To determine the correlation between a clinical measure of function in patients after first stroke and left-right scalp amplitude of visual evoked potentials using a theoretical model of the head.
Design:
A random sample of first-stroke patients underwent routine function measurement and investigation of left-right scalp potential asymmetry. Results of the encephalographic tests were compared with those of a healthy subject. To examine the effect of the conductivity in the damaged area on the potential asymmetry, numerical calculations were performed on a model, with four concentric circular compartments representing the brain, cerebrospinal fluid layer, skull, and scalp. The damaged region was modeled as a circular section.
Setting:
Neurologic rehabilitation ward of a major rehabilitation hospital and university-affiliated biomedical engineering laboratory.
Patients:
Four men aged 58 to 71 years, 3 with brain thrombosis and 1 with hemorrhagic stroke. The patients were admitted for rehabilitation an average of 3 weeks after the stroke and stayed for an average of 137 days. Damage was confined to the right brain in all cases; three of the patients had neglect syndrome and/or sensory disturbances. A healthy subject without stroke was also examined.
Measures:
Function was measured with the Functional Independence Measure (FIM) at 48 to 72 hours from admission and during the last week before discharge. Functional gain was calculated by subtracting the FIM admission score from the discharge score. Left-right scalp visual evoked potential amplitude was studied with flash stimuli according to the 10-20 international system and a theoretical model of the head based on two-dimensional computed tomography images; the volume conductor equation was solved numerically using the finite volume method. Left-right potential asymmetry and the damaged-region-to-brain-area ratio were calculated and correlated with the FIM values by linear regression analysis. Negative asymmetry indicates that the activity in the right damaged hemisphere is lower than in the undamaged one.
Results:
A negative correlation was noted between the FIM score on admission and the left-right scalp potential amplitude asymmetry, and between the FIM gain and the damaged-region-to-brain-area ratio obtained from the computed tomography image. Asymmetry was negative in the thrombotic patients and positive in the hemorrhagic one. The healthy subject showed nonsignificant asymmetry.
Conclusion:
A relationship might exist between the left-right asymmetry of the scalp visual evoked potential and both the damaged-region-to-brain-area ratio and the functional outcome of rehabilitation in poststroke patients. The modeling study shows that the left-right asymmetry is most likely the result of changes in the conductivity at the damaged area, which, in turn, are probably associated with patient functional status and evolution. Further validation in larger groups of patients and normal subjects is needed before these parameters can serve as useful indices for clinical purposes.