PATTERNS OF CENTRAL MOTOR REORGANIZATION IN HEMIPLEGIC CEREBRAL-PALSY
PATTERNS OF CENTRAL MOTOR REORGANIZATION IN HEMIPLEGIC CEREBRAL-PALSY
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DOI：
10.1093/brain/116.5.1223
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发表时间：
1993-10-01
期刊：
影响因子：
14.5
通讯作者：
STEPHENS, JA
中科院分区：
文献类型：
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作者：
CARR, LJ;HARRISON, LM;STEPHENS, JA
对33例脑性瘫痪患者进行了中枢运动重组研究。皮质脊髓的预测进行了调查，使用局灶性磁刺激的运动皮层。用数字神经刺激检查反射通路。交叉相关分析的多单位肌电图被用来检测活动的分支共同干最后一阶突触前输入运动神经元池。神经生理学检查结果与临床结果相关，在21例（64%）研究对象中，有证据表明中枢运动通路重组。临床和神经生理学结果显示两种不同形式的重组。在这两种形式的局灶性磁刺激表现出新的同侧运动通路从未受损的运动皮层偏瘫手。同侧的预测没有表现出从受损的运动皮层。11名受试者有剧烈的轻微运动。在这些科目的交叉相关分析和反射测试表明，皮质脊髓轴突分支异常，并预计双边同源运动神经元池两侧的脊髓。其余10名受试者没有强烈的镜像运动，在这些科目中，没有证据表明最后一个订单分支的corticosporinal axons.It被发现，偏瘫手的良好功能与存在的EMG反应，在那只手磁刺激对侧运动皮层。当没有EMG反应时，除非受试者有强烈的镜像运动，否则手的功能很差。
Central motor reorganization was studied in 33 subjects with hemiplegic cerebral palsy. Corticospinal projections were investigated using focal magnetic stimulation of the motor cortex. Reflex pathways were examined with digital nerve stimulation. Cross-correlation analysis of multi-unit EMG was used to detect activity in branched common stem last order presynaptic inputs to motor neuron pools. The neurophysiological findings were related to the clinical outcome.In 21 of the subjects studied (64%), there was evidence for reorganization of central motor pathways. The clinical and neurophysiological findings revealed two different forms of reorganization. In both forms focal magnetic stimulation demonstrated novel ipsilateral motor pathways from the undamaged motor cortex to the hemiplegic hand. Ipsilateral projections were not demonstrated from the damaged motor cortex. Eleven subjects had intense minor movements. In these subjects cross-correlation analysis and reflex testing suggested that corticospinal axons had branched abnormally and projected bilaterally to homologous motor neuron pools on both sides of the spinal cord. The remaining 10 subjects did not have intense mirror movements and in these subjects there was no evidence for last order branching of corticospinal axons.It was found that good function of the hemiplegic hand was associated with the presence of EMG responses in that hand following magnetic stimulation of the contralateral motor cortex. When EMG responses were absent, hand function was poor unless the subject had intense mirror movements.