Timing dependent synergies between motor cortex and posterior spinal stimulation in humans.
Timing dependent synergies between motor cortex and posterior spinal stimulation in humans.
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人类运动皮层和后脊髓刺激之间的时间依赖性协同作用。
DOI：
10.1101/2023.08.18.23294259
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发表时间：
2023
期刊：
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M
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作者：
McIntosh,JamesR;Joiner,EvanF;Goldberg,JacobL;Greenwald,Phoebe;Murray,LyndaM;Thuet,Earl;Modik,Oleg;Shelkov,Evgeny;Lombardi,JosephM;Sardar,ZeeshanM;Lehman,RonaldA;Chan,AndrewK;Riew,KDaniel;Harel,NoamY;Virk,MichaelS;M
摘要意志运动需要来自运动皮层的下行输入和通过脊髓的感觉反馈。我们之前在大鼠中开发了一种配对的大脑和脊髓电刺激方法，该方法依赖于颈髓中下行运动和脊髓感觉刺激的汇聚。这种方法通过联想可塑性增强了感觉运动回路并改善了意志运动。在人类中，目前尚不清楚针对感觉运动界面的后硬膜外脊髓刺激或针对运动系统的前硬膜外脊髓刺激是否能有效促进大脑诱发反应。在 59 名接受选择性颈椎减压手术的个体中，用头皮电极刺激运动皮层，用硬膜外电极刺激脊髓，记录手臂和腿部肌肉的肌肉反应。脊髓电极放置在后面或前面，并且皮质和脊髓刺激之间的间隔是不同的。运动皮层和脊髓感觉（后部）刺激而非脊髓运动（前部）刺激之间的配对刺激产生的运动诱发电位比单独的大脑刺激大五倍以上。仅当下行运动和脊髓传入刺激定时在脊髓中汇聚时，才会发生这种强烈的增强。相对于未配对的大脑或脊髓刺激，配对刺激还增加了肌肉反应的选择性。最后，临床体征表明，在脊髓损伤和未损伤的部分都观察到了促进作用。这种配对刺激的大效应使其成为治疗性神经调节的有希望的候选者。关键点旨在改变神经系统功能的刺激对通常以运动系统为目标，或者一个以感觉系统为目标，另一个以运动系统为目标，以实现皮层的收敛。在接受临床指示手术的人类中，我们测试了我们在大鼠中开发的配对大脑和脊髓刺激，旨在针对颈髓中的感觉运动收敛。手臂和手部肌肉对配对感觉运动刺激的反应比当应用于后部脊髓而不是前部脊髓时，仅对大脑或脊髓进行刺激。手臂和手部肌肉对配对刺激的反应比仅针对大脑或脊髓的条件对目标肌肉更具选择性，特别是在配对刺激产生最强效果的潜伏期。压迫的临床证据的测量与配对刺激效果仅微弱相关，这表明它可以用作受中枢神经系统疾病影响的人的治疗。
AbstractVolitional movement requires descending input from the motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans, it is not known whether posterior epidural spinal cord stimulation targeted at the sensorimotor interface or anterior epidural spinal cord stimulation targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord was stimulated with epidural electrodes, with muscle responses being recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, clinical signs suggest that facilitation was observed in both injured and uninjured segments of the spinal cord. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation.Key pointsPairs of stimuli designed to alter nervous system function typically target the motor system, or one targets the sensory system and the other targets the motor system for convergence in cortex.In humans undergoing clinically indicated surgery, we tested paired brain and spinal cord stimulation that we developed in rats aiming to target sensorimotor convergence in the cervical cord.Arm and hand muscle responses to paired sensorimotor stimulation were more than five times larger than brain or spinal cord stimulation alone when applied to the posterior but not anterior spinal cord.Arm and hand muscle responses to paired stimulation were more selective for targeted muscles than the brain‐ or spinal‐only conditions, especially at latencies that produced the strongest effects of paired stimulation.Measures of clinical evidence of compression were only weakly related to the paired stimulation effect, suggesting that it could be applied as therapy in people affected by disorders of the central nervous system.