Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis.
Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis.
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DOI：
10.1177/1545968315594886
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发表时间：
2016-05
影响因子：
4.2
通讯作者：
Cohen LG
中科院分区：
文献类型：
--
作者：
Harris-Love ML;Chan E;Dromerick AW;Cohen LG
在恢复良好并保留手运动的中风患者中，运动功能障碍与受累手部肌肉的大脑半球间和皮质内抑制有关。在无法移动手的康复程度较低的患者中，恢复的手臂运动的神经基础对日常生活任务的执行至关重要，但还没有得到很好的了解。在这里，我们评估了手部活动没有恢复的患者(n=16，上肢Fugl-Meyer评估=27.0±8.6)瘫痪臂肌肉的大脑半球间和皮质内抑制。我们记录了经颅磁刺激(TMS)在偏瘫二头肌和肱三头肌(分别与皮质内抑制和大脑半球间抑制相关)的随意等长收缩过程中引起的静默期(对侧和同侧)，并调查了静默期和运动恢复之间的联系，这是一个以前没有探索过的问题。我们报告说，大脑半球间抑制，在偏瘫的三头肌中比在二头肌中更强，与残存损伤的程度显著相关(Fugl-Meyer评分较低)。相反，偏瘫患者的二头肌皮质内抑制与运动恢复呈正相关(Fugl-Meyer评分)，与痉挛呈负相关(修改后的Ashworth评分较低)，而在三头肌中没有。我们的结果表明，偏瘫患者上臂肌肉的半球间抑制和皮质内抑制以不同的方式与运动恢复有关。虽然大脑半球间抑制可能导致较差的恢复，但肌肉特异性皮质内抑制可能与成功的运动恢复和较少的痉挛有关。
In well-recovered stroke patients with preserved hand movement, motor dysfunction relates to interhemispheric and intracortical inhibition in affected hand muscles. In less fully recovered patients unable to move their hand, the neural substrates of recovered arm movements, crucial for performance of daily living tasks, are not well understood. Here, we evaluated interhemispheric and intracortical inhibition in paretic arm muscles of patients with no recovery of hand movement (n=16, upper extremity Fugl-Meyer Assessment = 27.0 ± 8.6). We recorded silent periods (contralateral and ipsilateral) induced by transcranial magnetic stimulation (TMS) during voluntary isometric contraction of the paretic biceps and triceps brachii muscles (correlates of intracortical and interhemispheric inhibition respectively), and investigated links between the silent periods and motor recovery, an issue that has not been previously explored. We report that interhemispheric inhibition, stronger in the paretic triceps than biceps brachii muscles, significantly correlated with the magnitude of residual impairment (lower Fugl-Meyer scores). In contrast, intracortical inhibition in the paretic biceps brachii, but not in the triceps, correlated positively with motor recovery (Fugl-Meyer scores) and negatively with spasticity (lower Modified Ashworth scores). Our results suggest that interhemispheric inhibition and intracortical inhibition of paretic upper arm muscles relate to motor recovery in different ways. While interhemispheric inhibition may contribute to poorer recovery, muscle-specific intracortical inhibition may relate to successful motor recovery and lesser spasticity.