Regional spontaneous brain activity abnormalities in ischemic stroke patients with motor dysfunction: protocol for an AES-SDM coordinate-based meta-analysis.

Abstract

Introduction: Most ischemic stroke survivors experience motor deficits, yet the underlying patterns of spontaneous brain activity change remain unclear. Individual rs-fMRI studies on this population have yielded contradictory findings, likely due to small sample sizes and between-study differences in lesion profiles, stroke stage, rehabilitation history, and imaging pipelines. These inconsistencies have not been resolved by existing reviews, many of which combine ischemic and hemorrhagic stroke, pool conceptually distinct rs-fMRI metrics without sufficient stratification, or focus on functional connectivity rather than local spontaneous activity. This protocol plans a coordinate-based meta-analysis restricted to ischemic stroke and local rs-fMRI metrics to address that gap.

Methods and analysis: This study will systematically identify and synthesise whole-brain rs-fMRI studies that compared ALFF, fALFF, or ReHo between adult ischemic stroke patients with motor dysfunction and healthy controls. We will search PubMed, Embase, Web of Science, and the Cochrane Library up to 6 February 2026. To be included, a study must report whole-brain voxel-wise group comparisons and provide stereotactic peak coordinates in MNI or Talairach space. Studies will be excluded if they are non-original reports, case reports or case series, use task-state fMRI or ROI-only analyses, lack extractable standard-space coordinates, involve duplicate or overlapping datasets, include hemorrhagic or mixed stroke without separable ischemic-stroke data, or do not provide clearly extractable motor dysfunction-related data. Two reviewers will independently screen, extract, and assess methodological quality. Using anisotropic effect-size seed-based d mapping (AES-SDM), the quantitative synthesis will pool coordinates to detect convergent patterns of both increased and decreased regional spontaneous activity. Where data allow, we will conduct subgroup analyses, jackknife sensitivity testing, heterogeneity assessment, and meta-regression. The protocol follows the PRISMA-P statement, and the completed review will adhere to PRISMA 2020.

Conclusion: This protocol outlines a systematic review and AES-SDM coordinate-based meta-analysis aimed at synthesizing regional spontaneous activity abnormalities in ischemic stroke patients with motor dysfunction. The results should identify convergent areas of local functional alteration, generating testable predictions for future research on post-stroke motor-network reorganization and rehabilitation.

Clinical trial registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359426, identifier CRD420261359426.