Effects of Temporary Functional Deafferentation on the Brain, Sensation, and Behavior of Stroke Patients
Effects of Temporary Functional Deafferentation on the Brain, Sensation, and Behavior of Stroke Patients
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DOI：
10.1523/jneurosci.5912-11.2012
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发表时间：
2012-08-22
影响因子：
5.3
通讯作者：
Weiss, Thomas
中科院分区：
文献类型：
--
作者：
Sens, Elisabeth;Teschner, Ulrike;Weiss, Thomas
中风后，许多患者会出现慢性运动障碍，受中风影响的身体部位的体感减少。最近的实验研究表明，暂时性功能性传入神经分离（TFD）可能会改善中风患者的感觉运动能力。本研究寻找脑卒中前臂经药物诱导的TFD后皮层重组和相关感觉和运动改善的证据。在约束诱导运动治疗的第2天进行检查。36名患者在2天内用麻醉药膏（含利多卡因和丙罗卡因）对中风影响的前臂进行治疗，另一天使用安慰剂药膏。TFD和安慰剂治疗的顺序在患者之间是平衡的。通过光栅定向任务和形状-分类-鼓任务以及体感诱发磁场来评估体感和运动表现。诱发磁场在TFD期间对中风手的拇指触觉刺激的反应中显示出显著的评估前和评估后的幅度增加，但在安慰剂治疗后没有。我们还观察到，在TFD治疗后，受中风影响的拇指和小指皮层表征之间的距离迅速延长，而安慰剂治疗后则没有。此外，受中风影响的手的体感和运动表现在TFD治疗期间显著增强，而在安慰剂治疗期间则没有。因此，药物诱导的中风前臂TFD可能改善中风上肢的体感觉和运动功能，并伴有皮质可塑性。
Following stroke, many patients suffer from chronic motor impairment and reduced somatosensation in the stroke-affected body parts. Recent experimental studies suggest that temporary functional deafferentation (TFD) of parts of the stroke-affected upper limb or of the less-affected contralateral limb might improve the sensorimotor capacity of the stroke-affected hand. The present study sought evidence of cortical reorganization and related sensory and motor improvements following pharmacologically induced TFD of the stroke-affected forearm.Examination was performed during 2 d of Constraint-Induced Movement Therapy. Thirty-six human patients were deafferented on the stroke-affected forearm by an anesthetic cream (containing lidocaine and prilocaine) on one of the 2 d, and a placebo cream was applied on the other. The order of TFD and placebo treatment was counterbalanced across patients. Somatosensory and motor performance were assessed using a Grating orienting task and a Shape-sorter-drum task, and with somatosensory-evoked magnetic fields. Evoked magnetic fields showed significant pre- to postevaluation magnitude increases in response to tactile stimulation of the thumb of the stroke-affected hand during TFD but not following placebo treatment. We also observed a rapid extension of the distance between cortical representations of the stroke-affected thumb and little finger following TFD but not following placebo treatment. Moreover, somatosensory and motor performance of the stroke-affected hand was significantly enhanced during TFD but not during placebo treatment. Thus, pharmacologically induced TFD of a stroke-affected forearm might improve the somatosensory and motor functions of the stroke-affected upper limb, accompanied by cortical plasticity.