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Involvement of the posterior parietal cortex in the control of upper limb function and post-stroke spatial attention : study and modulation of the connectivity of the controlled posterior parietal cortex





The posterior parietal cortex (PPC) is a key structure for sensorimotor integration. It forms with the frontal areas to which it is connected the parieto-frontal networks that have specialized functions. It is involved in the planning and online control of visually-guided prehension but also in the control of spatial attention. Upper limb impairment and spatial neglect are two frequent and disabling consequences of stroke. In these two deficiencies, it has been shown that cerebral connectivity in the parieto-frontal networks is modified within the lesioned hemisphere, but also towards and within the non-lesioned hemisphere due to an imbalance in the interhemispheric influences between parietal areas. Furthermore, these modifications seem to be involved in the genesis and/or the recovery of spatial neglect and motor deficiency. However, the changes in connectivity remain partly unknown, especially if we consider the different PPC functional areas identified in healthy subjects in the PPC (anterior and posterior parts of the intraparietal sulcus (respectively aIPS and pIPS) and the superior parieto-occipital cortex (SPOC)). The aims of the present work were (1) to study the modifications of intra- and interhemispheric cerebral connectivity of these 3 PPC areas in post-stroke patients vs healthy controls, (2) determine the relationship between connectivity data and the severity of motor and visuo-spatial deficiencies, and (3) study the effect of a modulation of the PPC on these deficiencies.We first assessed the connectivity of parieto-frontal networks within the contralesional hemisphere using a paired-pulse transcranial magnetic stimulation protocol (ppTMS). In a second study, we addressed the functional (resting state fMRI) and structural (fractional anisotropy on diffusion weighted imagery) intra- and interhemispheric connectivity of the contralesional PPC. We finally study the effect of an inhibitory modulation of the contralesional PPC (continuous theta-burst stimulation (cTBS)) on reaching parameters with the paretic upper limb in stroke patients.In the first study, we demonstrated an hyperexcitability of parieto-frontal connections in neglect patients when the conditioning stimulus was applied over the SPOC, especially when peripersonal neglect was severe. Connectivity between the aIPS and M1 was not different between patients and healthy controls and the severity of motor deficiency was not associated with connectivity. The neuroimaging study revealed that functional and structural connectivity from the contralesional PPC was altered in stroke patients, within the contralesional hemisphere but also to the lesioned hemisphere, in different ways depending on the PPC site considered. Functional connectivity showed some relationships with neglect severity but almost not with motor deficiency. Finally, the inhibition of the contralesional PPC lead by a cTBS protocol may increase lesioned M1 excitability and some spatiotemporal parameters of pointing movements.In conclusion, post-stroke patients showed wide modifications of cerebral connectivity of the contralesional PPC, both within the contralesional and toward the lesioned hemisphere. Whereas we identified links between connectivity and neglect severity, relationships were poorer with motor deficiency, certainly since this last is determined by several other factors. Finally, this work puts light on new perspectives of modulation protocols using non-invasive brain stimulation in stroke patients.

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