Motor representation in patients rapidly recovering after stroke:: a functional magnetic resonance imaging and transcranial magnetic stimulation study
Motor representation in patients rapidly recovering after stroke:: a functional magnetic resonance imaging and transcranial magnetic stimulation study
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DOI：
10.1016/s1388-2457(03)00263-3
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发表时间：
2003-12-01
影响因子：
4.7
通讯作者：
Töpper, R
中科院分区：
文献类型：
--
作者：
Foltys, H;Krings, T;Töpper, R
目的：神经影像学研究提示脑卒中后运动恢复过程中脑激活模式的演变。最初，运动表现不佳与未受伤半球的募集相关，该募集持续消失，直到达到接近正常（对侧）的激活模式，并且运动表现良好。在这里，我们感兴趣的早期脑激活模式的患者表现出良好的和快速的恢复中风后stroke.Methods：10例首次缺血性中风影响运动areas进行自我起搏的简单或更复杂的运动与受影响的或未受影响的手在功能磁共振成像（fMRI）。确定高于阈值的激活体素的位置和数量。为了研究皮层运动输出图的可能变化，使用经颅磁刺激（TMS）确定运动诱发电位（MEP）的幅度和可兴奋区的范围。结果：观察到的激活模式与患手和未患手的运动相似。在简单运动任务中，与健侧手相比，患侧手在运动同侧的初级运动皮层、辅助运动区和运动对侧的小脑半球的运动功能显著增加（P < 0.05）。当比较简单与更复杂的运动进行与任何受影响或未受影响的手，进一步的趋势，增加激活运动区观察。与未受影响的半球相比，从受影响的半球获得的MEP幅度较小，皮层输出地图的范围也有所减少;但当刺激同侧未受影响的运动皮层时，没有患者在受影响的手显示MEP。尽管运动功能恢复迅速，几乎完全恢复，但大脑激活模式与大脑活动增加有关。（双侧）运动区，如fMRI所示。TMS显示受损的运动输出特性，但未能证明同侧运动通路。因此，我们的患者的成功康复可能依赖于因损伤而幸免于难的现有运动网络的双侧激活增加。(C)2003年国际临床神经生理学联合会。由Elsevier爱尔兰有限公司出版。保留所有权利。
Objective: Neuroimaging studies have suggested an evolution of the brain activation pattern in the course of motor recovery after stroke. Initially poor motor performance is correlated with an recruitment of the uninjured hemisphere that continuously vanished until a nearly normal (contralateral) activation pattern is achieved and motor performance is good. Here we were interested in the early brain activation pattern in patients who showed a good and rapid recovery after stroke.Methods: Ten patients with first-ever ischemic stroke affecting motor areas had to perform self-paced simple or more complex movements with the affected or the unaffected hand during functional magnetic resonance imaging (fMRI). The location and number of activated voxels above threshold were determined. To study possible changes in the cortical motor output map the amplitude of the motor evoked potentials (MEP) and the extent of the excitable area were determined using transcranial magnetic stimulation (TMS).Results: The pattern of activation observed with movements of the affected and the unaffected hand was similar. In the simple motor task significant (P < 0.05) increases were found in the primary motor cortex ipsilateral to the movement, the supplementary motor area and the cerebellar hemisphere contralateral to the movement during performance with the affected hand compared to movements with the unaffected hand. When comparing simple with more complex movements performed with either the affected or the unaffected hand, a further tendency to increased activation in motor areas was observed. The amplitude of MEPs obtained from the affected hemisphere was smaller and the extent of cortical output maps was decreased compared to the unaffected hemisphere; but none of the patients showed MEPs at the affected hand when the ipsilateral unaffected motor cortex was stimulated.Conclusions: Despite a rapid and nearly complete motor recovery the brain activation pattern was associated with increased activity in (bilateral) motor areas as revealed with fMRI. TMS revealed impaired motor output properties, but failed to demonstrate ipsilateral motor pathways. Successful recovery in our patients may therefore rely on the increased bilateral activation of existing motor networks spared by the injury. (C) 2003 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.