Crossed cortico-spinal motor control after capsular stroke
Crossed cortico-spinal motor control after capsular stroke
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DOI：
10.1111/j.1460-9568.2007.05526.x
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发表时间：
2007-05-01
影响因子：
3.4
通讯作者：
Gerloff, Christian
中科院分区：
文献类型：
--
作者：
Braun, Christoph;Staudt, Martin;Gerloff, Christian
虽然人们普遍认为多个非初级运动区（例如背侧前运动皮层）有助于中风恢复，但同侧和对侧初级运动皮层（M1）的贡献存在争议。有人建议，恢复“接近正常”的激活模式是恢复功能的良好策略[Baron 等人，(2004) Cerebrovasc。第 18 页，260-267；沃德和科恩，（2004）Arch。神经学，61，1844-1848]。本研究通过在横断面设计中结合经颅磁刺激 (TMS) 和脑磁图 (MEG) 来解决中风恢复的这一问题，对象是 9 名皮质下中风后 17.6 +/- 5.5 个月（平均值 +/- SD）运动功能恢复良好的患者。 TMS 用于探测静息时皮质脊髓束 (CST) 的完整性，而 MEG 用于测试运动挑战期间 CST 通路的募集情况 [精确握力任务中的皮质肌肉一致性 (CMC)]。通过这两种技术，可以证明交叉的皮质-脊髓连接性。 CMC 大小和恢复的肌肉力量之间的显着相关性 (r= 0.85) 强调了交叉 CST 完整性与成功恢复的功能相关性。总之，在描述性水平上，交叉 CST 连接是康复良好的囊性中风患者的常见现象。这使得维持或重新使用交叉 CST 纤维可能是实现有效恢复的一种方法。
While it is widely accepted that multiple nonprimary motor areas such as the dorsal premotor cortex contribute to recovery from stroke, the contribution of the ipsilesional and contralesional primary motor cortex (M1) is controversial. It has been suggested that re-instating 'near normal' activation patterns is a good strategy for recovery of function [Baron et at., (2004) Cerebrovasc. Dis., 18, 260-267; Ward & Cohen, (2004) Arch. Neurol., 61, 1844-1848]. The present study addressed this aspect of stroke recovery by combining transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) in a cross-sectional design on nine patients with well-recovered motor function 17.6 +/- 5.5 months (mean +/- SD) after subcortical stroke. While TMS was applied to probe the integrity of the cortico-spinal tract (CST) at rest, MEG was used to test for recruitment of CST pathways during a motor challenge [cortico-muscular coherence (CMC) in a precision grip task]. With both techniques, crossed cortico-spinal connectivity could be demonstrated. A significant correlation (r= 0.85) of CMC magnitude and recovered muscle strength underlined the functional relevance of crossed CST integrity for successful recovery. In conclusion, at the descriptive level, crossed CST connectivity is a common finding in well-recovered patients with capsular stroke. This renders it likely that maintaining or regaining use of crossed CST fibers is one way to achieve effective recovery.