The potential dual role of transcallosal inhibition in post-stroke motor recovery
The potential dual role of transcallosal inhibition in post-stroke motor recovery
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DOI：
10.3233/rnn-170778
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Fregni, Felipe
中科院分区：
文献类型：
--
作者：
Bertolucci, Federica;Chisari, Carmelo;Fregni, Felipe
迄今为止，脑卒中后运动障碍及其恢复的机制一直被认为是基于脑内竞争模型。该模型假设抑制对侧半球的兴奋性将通过减少脑卒中半球的经胼胝体抑制（TCI）来增强恢复，根据该模型，许多临床试验使用非侵入性脑刺激来改善运动功能。尽管有一些积极的发现，但荟萃分析显示了结果中一个重要的变异性来源，质疑半球间竞争模型是否足以详尽地解释积极的结果，或者是否其他机制可以解释对侧半球抑制性刺激的运动效应。本研究的目的是回顾脑卒中后TCI增加与运动障碍之间的关系。系统回顾了通过经颅磁刺激（TMS）对脑卒中患者进行TCI的临床研究，以及该指标与运动恢复的关系。在PubMed进行文献检索后，纳入了11篇文章。对几个协变量的潜在作用进行了检验和讨论。总的来说，TCI作为一种假定的对侧半球刺激机制的重要性似乎取决于基线运动功能。换句话说，从主要来自慢性患者的证据来看，异常TCI的调节似乎对运动功能良好的患者有用，而对运动功能差的患者则不那么重要。TCI似乎与双亲手的镜像运动呈负相关。由此可以推断，抑制对侧半球的活动对运动残余功能良好、TCI较强的患者有利，而对运动功能较差、TCI较弱的患者不利。在临床试验中对患者进行分层和设计定制治疗时，应考虑到基线运动功能和TCI测量。
Up to now, the mechanism of motor impairment and recovery after stroke has been thought to be based on the interhemispheric competition model. According to this model, which assumes that suppressing the excitability of contralesional hemisphere will enhance recovery by reducing transcallosal inhibition (TCI) of the stroke hemisphere, many clinical trials used non-invasive brain stimulation to improve motor function. Despite some positive findings, meta-analysis shows an important source of variability in the results, questioning whether the interhemispheric competition model would be exhaustive enough to explain the positive results or whether other mechanisms could explain the motor effects of inhibitory stimulation in the contralesional hemisphere. The goal of this study was to review the relationship between increased TCI and motor impairment after stroke.A systematic review of clinical studies investigating TCI through transcranial magnetic stimulation (TMS) in stroke patients and the relationship of this metric with motor recovery was then performed. After a literary search in PubMed eleven articles were included. The potential role of several covariates was examined and discussed.Overall, the importance of TCI as a putative mechanism for stimulation of the contralesional hemisphere seems to depend on the baseline motor function. In other words, from evidence coming mostly from chronic patients, modulation of abnormal TCI seems to be useful for patients with good motor function and less important in patients with poor motor function. TCI seems to be negatively correlated with mirror movements of the paretic hand. It can be inferred that suppressing the activity of the contralesional hemisphere could be beneficial for patients with good residual motor function and strong TCI, but not for those with poor motor function and weak TCI. Baseline motor function and measure of TCI should be taken into account for stratification of patients in clinical trials and for the design of customized treatment.