Proportional Recovery After Stroke Depends on Corticomotor Integrity
Proportional Recovery After Stroke Depends on Corticomotor Integrity
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DOI：
10.1002/ana.24472
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发表时间：
2015-12-01
影响因子：
11.2
通讯作者：
Ackerley, Suzanne J.
中科院分区：
文献类型：
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作者：
Byblow, Winston D.;Stinear, Cathy M.;Ackerley, Suzanne J.
目的：对于大多数患者，卒中后前6个月内上肢功能障碍的恢复是最大可能的70%。我们试图确定这种成比例恢复的候选机制。我们假设，上肢功能障碍的比例分辨率取决于同侧皮质运动通路功能，反映了在这条通路的兴奋性的比例恢复，是不受上肢therapeutic dose.Methods：上肢功能障碍测定93例患者在2，6，12，和26周后首次缺血性中风。运动诱发电位（MEP）和运动阈值记录从桡侧腕伸肌使用经颅磁刺激，和分数各向异性（FA）在后肢的内部capsules测定与扩散加权磁共振imaging.Results：初始损伤评分，MEP和FA的不对称性的存在是唯一的预测障碍的决议，表明皮质运动束功能的关键作用。到12周时，MEP患者的上肢损伤消退了70%，无论其最初的损伤如何，同病灶静息运动阈值也消退了70%。损伤的分辨率是不敏感的上肢therapeutic dose.Interpretation：这些研究结果表明，上肢损伤解决了70%的最大可能的，无论最初的损害，但只有与完整的corticomotor功能的患者。损伤的解决似乎反映了自发的神经生物学过程，涉及同病皮质运动通路。更好地了解这些机制可能会导致干预措施，增加70%以上的损害的分辨率。
Objective: For most patients, resolution of upper limb impairment during the first 6 months poststroke is 70% of the maximum possible. We sought to identify candidate mechanisms of this proportional recovery. We hypothesized that proportional resolution of upper limb impairment depends on ipsilesional corticomotor pathway function, is mirrored by proportional recovery of excitability in this pathway, and is unaffected by upper limb therapy dose.Methods: Upper limb impairment was measured in 93 patients at 2, 6, 12, and 26 weeks after first-ever ischemic stroke. Motor evoked potentials (MEPs) and motor threshold were recorded from extensor carpi radialis using transcranial magnetic stimulation, and fractional anisotropy (FA) in the posterior limbs of the internal capsules was determined with diffusion-weighted magnetic resonance imaging.Results: Initial impairment score, presence of MEPs and FA asymmetry were the only predictors of impairment resolution, indicating a key role for corticomotor tract function. By 12 weeks, upper limb impairment resolved by 70% in patients with MEPs regardless of their initial impairment, and ipsilesional rest motor threshold also resolved by 70%. Resolution of impairment was insensitive to upper limb therapy dose.Interpretation: These findings indicate that upper limb impairment resolves by 70% of the maximum possible, regardless of initial impairment, but only for patients with intact corticomotor function. Impairment resolution seems to reflect spontaneous neurobiological processes that involve the ipsilesional corticomotor pathway. A better understanding of these mechanisms could lead to interventions that increase resolution of impairment above 70%.