MOTOR REORGANIZATION AFTER UPPER LIMB AMPUTATION IN MAN - A STUDY WITH FOCAL MAGNETIC STIMULATION
MOTOR REORGANIZATION AFTER UPPER LIMB AMPUTATION IN MAN - A STUDY WITH FOCAL MAGNETIC STIMULATION
复制标题
DOI：
10.1093/brain/114.1.615
复制
发表时间：
1991-02-01
期刊：
影响因子：
14.5
通讯作者：
HALLETT, M
中科院分区：
文献类型：
--
作者：
COHEN, LG;BANDINELLI, S;HALLETT, M
为了评估截肢后运动通路的重组，我们研究了7例单侧上肢截肢患者，1例先天性手缺失患者和10例正常人的经颅磁刺激运动诱发电位（MEP）。 肌电图记录从二头肌和三角肌近端的残端和相同的对侧肌肉。 磁刺激由Cadwell MES-10磁刺激器通过间隔1- 2.5cm的头皮位置上的“8字形”磁线圈递送。 最大的M反应引起周围神经刺激在Erb点。 MEP的幅度表示为绝对值和对周围神经刺激的最大反应的百分比。 对7例患者的断端同侧和对侧肌肉的激活阈值以及头皮兴奋部位进行了测定，磁刺激头皮可使后天性截肢患者的断端或手指产生运动感，而先天性截肢患者则不能产生这种感觉。 它引起了更大的MEP，招募了更大比例的运动神经元池，并引起MEP在较低强度的刺激同侧的肌肉比对侧肌肉的残端。 残肢同侧的肌肉比残肢对侧的肌肉可以从更大的区域被激活。 这些结果与成年人截肢后针对残肢近端肌肉的运动通路中的皮质或脊柱重组是相容的。
To evaluate reorganization in motor pathways following amputation, we studied motor evoked potentials (MEPs) to transcranial magnetic stimulation in 7 patients with unilateral upper limb amputations, a patient with congenital absence of a hand, and 10 normal subjects. Electromyographic recordings were made from biceps and deltoid muscles immediately proximal to the stump and the same contralateral muscles. Magnetic stimulation was delivered by a Cadwell MES-10 magnetic stimulator through a 'figure eight' magnetic coil over scalp positions separated by 1-2.5 cm. Maximal M responses were elicited by peripheral nerve stimulation at Erb's point. The amplitude of MEPs was expressed both as absolute values and as a percentage of maximal responses to peripheral nerve stimulation. Threshold for activation of muscles ipsilateral and contralateral to the stump and the region of excitable scalp positions were also determined in 7 patients.Magnetic scalp stimulation induced a sensation of movement in the missing hand or fingers in the patients with acquired amputation, but failed to do so in the patient with congenital absence of a limb. It evoked larger MEPs, recruited a larger percentage of the motoneuron pool, and elicited MEPs at lower intensities of stimulation in muscles ipsilateral to the stump than in contralateral muscles. Muscles ipsilateral to the stump could be activated from a larger area than those contralateral to the stump. These results are compatible with cortical or spinal reorganization in adult human motor pathways targeting muscles proximal to the stump after amputations.