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Wallerian degeneration of the pyramidal tract does not affect stroke rehabilitation outcome

From the Department of Neurology, Toneyama National Hospital (Drs. Miyai and Kang); and Bobath Memorial Hospital (Drs. Suzuki and Kubota, and K. Kii), Osaka, Japan.

Address correspondence and reprint requests to Dr. Ichiro Miyai, Department of Neurology, Toneyama National Hospital, 5-1-1, Toneyama, Toyonaka City, Osaka, 560-8552, Japan.

Objective: To test whether Wallerian degeneration (WD) of the pyramidal tract as signaled by MRI affects rehabilitation outcome in patients with subcortical infarction (internal capsule or corona radiata).

Background: Recent radiologic evidence suggests that WD occurs no earlier than 3 months after a subcortical infarction.

Methods: A total of 77 consecutive patients with pure motor hemiparesis due to an initial subcortical infarction were assessed on admission and discharge with the Functional Independence Measure (FIM) for disability and Stroke Impairment Assessment Set (SIAS, full = 25) for impairment. WD was defined by a high-intensity area detected along the pyramidal tract below the level of lesion on T2-weighted MR image (WD+).

Results: Age, sex, side of stroke, Mini-Mental State Examination score, and volume of lesion were comparable for each group. Length of stay (LOS) was significantly longer (p < 0.05) in WD+ (130 days) than in WD- (105 days). There was no difference in the change of FIM (WD+, 99 to 111; WD-, 95 to 107) or SIAS measures (WD+, 12 to 16; WD-, 13 to 16) made on admission and discharge, nor was there any effect of the timing of the rehabilitation experience (90 days or >90 days after stroke).

Conclusions: After stroke, apparent WD of the pyramidal tract may slow functional recovery but does not limit final rehabilitation outcome of pure motor hemiparesis. Study of the mechanisms of compensation for this delayed pyramidal tract degeneration will enhance the scientific basis for rehabilitation.

Supported by funds for comprehensive research on aging and health from Ministry of Health and Welfare, Japan.

Presented at the fifth annual meeting of the American Society of Neurorehabilitation; Minneapolis, MN; April 1998.

Received June 5, 1998. Accepted in final form August 8, 1998.

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