Intervention-Induced Motor Cortex Plasticity in Hemiparetic Children With Perinatal Stroke
Intervention-Induced Motor Cortex Plasticity in Hemiparetic Children With Perinatal Stroke
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DOI：
10.1177/1545968318801546
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发表时间：
2018-11-01
影响因子：
4.2
通讯作者：
Kirton, Adam
中科院分区：
文献类型：
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作者：
Kuo, Hsing-Ching;Zewdie, Ephrem;Kirton, Adam
背景临床试验表明，强化治疗结合脑刺激对改善围产期中风偏瘫儿童的手功能有效。然而，个体差异存在，潜在的神经可塑性机制是未知的。探索初级运动皮层（M1）神经生理学，以及它如何随着这些干预措施而变化，可能为推进个性化神经康复提供有价值的生物标志物。方法. 45名轻偏瘫儿童（年龄6-19岁）参加了PLASTIC CHAMPS，这是一项设盲、假对照、析因临床试验。所有患者均接受了80小时的目标导向强化上肢治疗。他们被随机分为4组：重复经颅磁刺激（rTMS）的对侧病变M1，约束疗法，两者兼而有之，或都没有。使用TMS研究了损伤和对侧损伤M1的刺激募集曲线（SRC）、短间隔皮质内抑制（SICI）和皮质内易化（ICF）。临床评估包括辅助手评估（AHA）和加拿大职业表现测量（COPM）进行干预前和干预后。结果所有儿童均完成了干预，功能（AHA）和目标表现（COPM）均得到改善，rTMS和约束的叠加效应（P <0.01）。干预后，运动诱发电位（MEP）幅度从对侧病变M1到较少受影响的手增加（n = 16，P <0.02）。从对侧病变M1到较少受累手的SRC增加（n = 25，P <0.01）。对侧病变M1对患侧手的SICI降低（n = 30，P <0.04）。两半球的ICF无明显变化（P > 0.12）。结论在强化神经调节治疗前后应用TMS可以探索脑瘫儿童M1的神经生理学和可塑性。MEP大小增加和SICI降低可能反映了干预性可塑性机制，并可能成为个体化药物的潜在生物标志物。
Background. Clinical trials are suggesting efficacy of intensive therapy combined with brain stimulation to improve hand function in hemiparetic children with perinatal stroke. However, individual variability exists and the underlying neuroplasticity mechanisms are unknown. Exploring primary motor cortex (M1) neurophysiology, and how it changes with such interventions, may provide valuable biomarkers for advancing personalized neurorehabilitation. Methods. Forty-five children (age 6-19 years) with hemiparesis participated in PLASTIC CHAMPS, a blinded, sham-controlled, factorial clinical trial. All received 80 hours of goal-directed intensive upper extremity therapy. They were randomized into 4 groups: repetitive transcranial magnetic stimulation (rTMS) of contralesional M1, constraint therapy, both, or neither. Stimulus recruitment curves (SRC), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) for lesioned and contralesional M1 were investigated using TMS. Clinical assessments including the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM) were conducted pre- and postintervention. Results. All children completed the intervention and both function (AHA) and goal performance (COPM) improved with additive effects of rTMS and constraint (P < .01). After intervention, motor-evoked potential (MEP) amplitudes from the contralesional M1 to the less-affected hand increased (n = 16, P < .02). SRC from the contralesional M1 to the less-affected hand increased (n = 25, P < .01). SICI of the contralesional M1 to the less-affected hand decreased (n = 30, P < .04). No changes were observed for ICF in either hemisphere (P > .12). Conclusion. TMS applied before/after intensive neuromodulation therapies can explore M1 neurophysiology and plasticity in children with cerebral palsy. Increased MEP sizes and decreased SICI may reflect mechanisms of interventional plasticity and be potential biomarkers of individualized medicine.