MOTOR RECOVERY FOLLOWING CAPSULAR STROKE - ROLE OF DESCENDING PATHWAYS FROM MULTIPLE MOTOR AREAS
MOTOR RECOVERY FOLLOWING CAPSULAR STROKE - ROLE OF DESCENDING PATHWAYS FROM MULTIPLE MOTOR AREAS
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DOI：
10.1093/brain/116.2.369
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发表时间：
1993-04-01
期刊：
影响因子：
14.5
通讯作者：
HAMBURGER, C
中科院分区：
文献类型：
--
作者：
FRIES, W;DANEK, A;HAMBURGER, C
通过定量评估 23 名囊性或纹状体囊性中风患者的运动功能，研究了运动恢复的功能解剖学。虽然选择性基底神经节病变（仅尾状核和/或壳核）不影响四肢的自主运动，但内囊前肢（加上尾状核/壳核）或后肢的病变导致最初严重的运动障碍，随后恢复良好，包括手功能。相反，内囊后肢的损伤加上外侧丘脑的损伤会损害运动结果。在对猕猴内囊地形的实验追踪中，我们发现初级运动皮层的轴突穿过内囊后肢的中间三分之一。前运动皮层（背外侧和后弓状区域 6）的轴突穿过膝关节囊，辅助运动区域（内侧区域 6）的轴突穿过前肢。因此，小的囊膜病变可以选择性地破坏功能和解剖学上不同的运动区域的输出。这些不同的下行运动通路破坏后，临床上相似的运动缺陷和相似的功能恢复过程表明皮质运动区域的并行操作。在偏瘫恢复过程中，它们可能具有在功能上相互替代的进一步能力。
The functional anatomy of motor recovery was studied by assessing motor function quantitatively in 23 patients following capsular or striatocapsular stroke. While selective basal ganglia lesions (caudate and/or putamen exclusively) did not affect voluntary movements of the extremities, lesions of the anterior (plus caudate/putamen) or posterior limb of the internal capsule led to an initially severe motor impairment followed by excellent recovery, hand function included. In contrast, lesions of the posterior limb of the internal capsule in combination with damage to lateral thalamus compromised motor outcome. In experimental tracing of the topography of the internal capsule in macaque monkeys, we found axons of primary motor cortex passing through the middle third of the posterior limb of the internal capsule. Axons of premotor cortex (dorsolateral and post-arcuate area 6) passed through the capsular genu, and those of supplementary motor area (mesial area 6) through the anterior limb. Small capsular lesion can therefore disrupt the output of functionally and anatomically distinct motor areas selectively. The clinically similar motor deficits with a similar course of functional restitution following disruption of these different descending motor pathways indicate a parallel operation of cortical motor areas. They may have the further capability of substituting each other functionally in the process of recovery from hemiparesis.