Differential effect of spinal cord injury and functional impairment on human brain activation
Differential effect of spinal cord injury and functional impairment on human brain activation
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DOI：
10.1089/089771502753460222
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发表时间：
2002-01-01
影响因子：
4.2
通讯作者：
Dietz, V
中科院分区：
文献类型：
--
作者：
Curt, A;Bruehlmeier, M;Dietz, V
电生理学研究表明，脊髓损伤（SCI）后人脑功能的重组。然而，目前尚不清楚SCI患者脑激活的变化在多大程度上受到SCI（神经元病变）或随之而来的功能障碍的影响。正电子发射断层扫描（[O-15]-H2O-PET）在SCI患者和健康受试者的单侧手部运动过程中进行。将截瘫和手功能正常的SCI患者与手运动受损的四肢瘫痪患者进行比较。截瘫患者和健康受试者之间的组间比较显示，对侧感觉运动皮层（SMC），对侧丘脑，同侧上级顶叶，双侧小脑的激活增加。与此相反，上肢功能受损的四肢瘫痪患者仅显示出辅助运动区（SMA）的显著激活。四肢瘫患者的相关分析表明，手运动的强度与对侧SMC的激活有关。然而，上肢感觉运动缺陷的严重程度与对侧SMA和同侧小脑的激活减少有关。研究结果表明，在手功能正常的截瘫患者的脊髓神经元损伤本身诱导重组的大脑激活无关的上肢功能。与此相比，在四肢瘫痪患者中，脑激活的变化与上肢功能受损有关。因此，在SCI患者中，脊髓损伤和功能障碍对大脑激活的影响不同。脊髓损伤患者的传入反馈受损和/或非受损肢体代偿性使用增加的影响需要进一步评估。
Reorganization of human brain function after spinal cord injury (SCI) has been shown in electrophysiological studies. However, it is less clear how far changes of brain activation in SCI patients are influenced by the extent of SCI (neuronal lesion) or the consequent functional impairment. Positron emission tomography ([O-15]-H2O-PET) was performed during an unilateral hand movement in SCI patients and healthy subjects. SCI patients with paraplegia and normal hand function were compared to tetraplegic patients with impaired hand movements. Intergroup comparison between paraplegic patients and healthy subjects showed an increased activation of contralateral sensorimotor cortex (SMC), contralateral thalamus, ipsilateral superior parietal lobe, and bilateral cerebellum. In contrast to this, tetraplegic patients with impaired upper limb function revealed only a significant activation of supplementary motor area (SMA). Correlational analysis in the tetraplegic patients showed that the strength of hand movement was related to the activation of contralateral SMC. However, the severity of upper limb sensorimotor deficit was related to a reduced activation of contralateral SMA and ipsilateral cerebellum. The findings suggest that in paraplegic patients with normal hand function the spinal neuronal lesion itself induces a reorganization of brain activation unrelated to upper limb function. Compared to this, in tetraplegic patients changes of brain activation are related to the impaired upper limb function. Therefore, in patients with SCI a differential impact of spinal lesion and functional impairment on brain activation can be shown. The effect of impaired afferent feedback and/or increased compensatory use of non-impaired limbs in SCI patients needs further evaluation.