Pre-therapy Neural State of Bilateral Motor and Premotor Cortices Predicts Therapy Gain After Subcortical Stroke: A Pilot Study.
Pre-therapy Neural State of Bilateral Motor and Premotor Cortices Predicts Therapy Gain After Subcortical Stroke: A Pilot Study.
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DOI：
10.1097/phm.0000000000000791
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发表时间：
2018-01
影响因子：
3
通讯作者：
Nudo RJ
中科院分区：
文献类型：
--
作者：
Cirstea CM;Lee P;Craciunas SC;Choi IY;Burris JE;Nudo RJ
研究治疗前捕获的备用运动和前运动皮层的神经状态（质子磁共振波谱，1H-MRS）是否能预测慢性皮质下卒中患者治疗相关的运动增益。10名患有慢性中度上肢（UE）损伤的幸存者在进行为期四周的损伤定向训练之前接受了1H-MRS、MRI、临床和运动学评估。治疗后重复进行临床/运动学评估，运动增加被定义为临床UE/肘部运动改变的正值和躯干运动改变的负值。候选预测因子是n -乙酰天冬氨酸-神经元标记物，谷氨酸-谷氨酰胺-谷氨酸神经传递指示物，以及肌醇-胶质标记物，在运动（M1）和运动前（运动前皮层- pm，补充运动区- sma）皮质的UE区域内双侧测量。传统的预测因素（年龄、卒中长度、治疗前UE临床损害、梗死体积）也进行了研究。运动增益差与单侧病变M1和PM中谷氨酸-谷氨酰胺水平较低（r=0.77, p=0.01和r=0.78, p=0.008）、单侧病变PM中n -乙酰天冬氨酸水平较低（r=0.69, p=0.02）、对照M1中谷氨酸-谷氨酰胺水平较高（r= - 0.68, p=0.03）和对照SMA中谷氨酸-谷氨酰胺水平较低（r=0.64, p=0.04）相关。这些预测指标优于肌醇指标和传统预测指标（p≈0.05-1.0）。双侧运动和前运动皮质的谷氨酸能状态和同侧运动前皮质的神经元状态可能是预测恢复性治疗中运动结果的重要因素。
To examine whether neural state (proton magnetic resonance spectroscopy, 1H-MRS) of spared motor and premotor cortices captured before a therapy predicts therapy-related motor gains in chronic subcortical stroke. Ten survivors, presenting chronic moderate upper extremity (UE) impairment, underwent 1H-MRS, MRI, clinical, and kinematics assessments prior a four-week impairment-oriented training. Clinical/kinematic assessments were repeated after therapy and motor gain was defined as positive values of clinical UE/elbow motion changes and negative values of trunk motion changes. Candidate predictors were N-acetylaspartate-neuronal marker, Glutamate-Glutamine-indicator of glutamatergic neurotransmission, and myo-Inositol-glial marker, measured bilaterally within the UE territory in motor (M1) and premotor (premotor cortex-PM, supplementary motor area-SMA) cortices. Traditional predictors (age, stroke length, pre-therapy UE clinical impairment, infarct volume) were also investigated. Poor motor gain was associated with lower Glutamate-Glutamine levels in ipsilesional M1 and PM (r=0.77, p=0.01 and r=0.78, p=0.008 respectively), lower N-acetylaspartate in ipsilesional PM (r=0.69, p=0.02), higher Glutamate-Glutamine in contralesional M1 (r=−0.68, p=0.03), and lower Glutamate-Glutamine in contralesional SMA (r=0.64, p=0.04). These predictors outperformed myo-Inositol metrics and traditional predictors (p≈0.05–1.0). Glutamatergic state of bilateral motor and premotor cortices and neuronal state of ipisilesional premotor cortex may be important for predicting motor outcome in the context of a restorative therapy.