{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:51:16Z","timestamp":1791359476855,"version":"4.3.1"},"reference-count":69,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":279,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI20\/01574"],"award-info":[{"award-number":["PI20\/01574"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006393","name":"Universidad de Granada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006393","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neural Plasticity"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>A magnetic resonance image (MRI) study recently described greater improvements in gray matter volume and cortical thickness in post\u2010stroke patients with upper\u2010limb spasticity treated with surgery versus botulinum toxin\u2010A (BoNT\u2010A).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare changes in the white matter of these patients after surgical versus BoNT\u2010A treatment and to relate findings to upper\u2010limb function and quality\u2010of\u2010life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a two\u2010arm randomized controlled clinical trial, 30 post\u2010stroke patients (&gt;12 months) with spastic upper limbs were recruited and randomly assigned (1:1) to surgery or BoNT\u2010A treatment (controls). Functional and quality\u2010of\u2010life parameters were studied at baseline (pre\u2010intervention) and at 6 months, while brain MRI scans of the white matter were taken at the same time points using a Siemens 3T Prisma MRI scanner. Although baseline MRI scans were obtained in all 30 participants, complete longitudinal MRI data were available for only 14 participants because of contraindications or refusal of follow\u2010up imaging. Therefore, the imaging analyses were considered only exploratory and hypothesis\u2010generating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Increased post\u2010 versus pre\u2010surgery fractional anisotropy (FA) values were associated with Carer Burden and House functional scale scores, and decreased FA values with Ashworth, Fugl\u2010Meyer, pain visual analogue scale, and SF\u201036 scores. Reduced mean diffusivity (MD) values for inferior fronto\u2010occipital fasciculus, cingulum parahippocampal parietal, uncinate fasciculus, and reticular tract were associated with improvements in Fugl\u2010Meyer motor recovery scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The post\u2013pre increase in FA of white matter tracts in the experimental versus control group may suggest differences in white matter microstructure between treatment groups, potentially reflecting neuroplastic changes. These findings suggest that changes in white matter microstructure might be associated with improvements in motor function, independence, and caregiver burden. However, given the small longitudinal MRI sample, the tract\u2010specific findings should be considered hypothesis\u2010generating and require confirmation in larger studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/np\/6479640","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:07:31Z","timestamp":1791356851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgery versus Botulinum Toxin A for Treatment of Post\u2010Stroke Upper\u2010Limb Spasticity: White Matter Changes, Function, and Quality\u2010of\u2010Life\u2014A Randomized Controlled Trial"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0554-5590","authenticated-orcid":false,"given":"Patricia","family":"Hurtado-Olmo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9629-3140","authenticated-orcid":false,"given":"Pedro","family":"Hern\u00e1ndez-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Surgery Department School of Medicine Granada University  Avenue Doctor Jes\u00fas Candel F\u00e1bregas 11 Granada 18016 Spain  ugr.es"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria IBS. 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