Functional lateralization in cingulate cortex predicts motor recovery after basal ganglia stroke

• A longitudinal study on basal ganglia (BG) stroke patients is performed.
• FMRI data were collected across three motor recovery stages.
• Close interactions between BG and cerebellum during motor recovery were revealed.
• Ipsilesional attention modulation in the early stage after BG stroke was revealed.
• Contralateral cingulate cortex activation was associated with an improved recovery.

The basal ganglia (BG) is involved in higher order motor control such as movement planning and execution of complex motor synergies. Neuroimaging study on stroke patients specifically with BG lesions would help to clarify the consequence of BG damage on motor control. In this paper, we performed a longitudinal study in the stroke patients with lesions in BG regions across three motor recovery stages, i.e., less than 2week (Session 1), 1–3 m (Session 2) and more than 3 m (Session 3). The patients showed an activation shift from bilateral hemispheres during early sessions (<3 m) to the ipsilesional cortex in late session (>3m), suggesting a compensation effect from the contralesional hemisphere during motor recovery. We found that the lateralization of cerebellum(CB) for affected hand task correlated with patients' concurrent Fugl-Meyer index (FMI) in Session 2. Moreover, the cingulate cortex lateralization index in Session 2 was shown to significantly correlate with subsequent FMI change between Session 3 and Session 2, which serves as a prognostic marker for motor recovery. Our findings consolidated the close interactions between BG and CB during the motor recovery after stroke. The dominance of activation in contralateral cingulate cortex was associated with a better motor recovery, suggesting the important role of ipsilesional attention modulation in the early stage after BG stroke.