Brain motor system function after chronic, complete spinal cord injury
Brain motor system function after chronic, complete spinal cord injury
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DOI：
10.1093/brain/awh648
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发表时间：
2005-12-01
期刊：
影响因子：
14.5
通讯作者：
Cohen, MJ
中科院分区：
文献类型：
--
作者：
Cramer, SC;Lastra, L;Cohen, MJ
大多数脊髓损伤(SCI)后恢复运动功能的治疗正在开发中，表现为完整的脑运动功能。为了验证这一假设，12名慢性完全性脊髓损伤患者和12名对照组在尝试和想象右脚运动的过程中接受了功能磁共振成像，每个人都有两种力量水平。在脊髓损伤患者中，许多正常的运动系统功能特征被保留下来，但有几个明显的偏离正常：(1)在信号变化的两倍正常变化的情况下，激活体积普遍大大减少，例如初级感觉运动皮质的激活体积是正常的4-8%；(2)存在异常的激活模式，例如在尝试运动时苍白球-丘脑皮质环活动增加，以及在想象运动中初级感觉运动皮质的异常加工；和(Iii)任务或力量水平变化对功能的调节不符合对照组的模式，例如，在对照组，左侧初级感觉运动皮质和右侧小脑背侧的想象运动比想象运动激活更多，而在背外侧前额叶皮质和右侧中央前回，想象运动比尝试运动激活更多。这些调节在脊髓损伤患者中是缺失的。慢性完全性脊髓损伤后，足部运动过程中脑运动系统功能的许多特征仍然存在。然而，患者存在大脑激活的严重紊乱，随着任务需求的变化而对功能调节不良，以及出现病理性脑事件。由于大脑功能是自主运动的核心，旨在改善慢性脊髓损伤后运动功能的干预措施可能也需要关注这些大脑功能的异常。
Most therapies under development to restore motor function after spinal cord injury (SCI) assume intact brain motor functions. To examine this assumption, 12 patients with chronic, complete SCI and 12 controls underwent functional MRI during attempted, and during imagined, right foot movement, each at two force levels. In patients with SCI, many features of normal motor system function were preserved, however, several departures from normal were apparent: (i) volume of activation was generally much reduced, e.g. 4-8% of normal in primary sensorimotor cortex, in the setting of twice normal variance in signal change; (ii) abnormal activation patterns were present, e.g. increased pallido-thalamocortical loop activity during attempted movement and abnormal processing in primary sensorimotor cortex during imagined movement; and (iii) modulation of function with change in task or in force level did not conform to patterns seen in controls, e.g. in controls, attempted movement activated more than imagined movement did within left primary sensorimotor cortex and right dorsal cerebellum, while imagined movement activated more than attempted movement did in dorsolateral prefrontal cortex and right precentral gyrus. These modulations were absent in patients with SCI. Many features of brain motor system function during foot movement persist after chronic complete SCI. However, substantial derangements of brain activation, poor modulation of function with change in task demands and emergence of pathological brain events were present in patients. Because brain function is central to voluntary movement, interventions that aim to improve motor function after chronic SCI likely also need to attend to these abnormalities of brain function.