Motor-Functional Neuroanatomy in Cerebral Palsy

脑瘫的运动功能神经解剖学

• 批准号: 7284984
• 负责人: GEORGE F. WITTENBERG
• 金额: $ 7.82万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-09 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7284984
• 关键词: brain imaging /visualization /scanning; brain mapping; cerebral palsy; clinical research; disabling disease; functional ability; functional magnetic resonance imaging; human subject; motor cortex; muscle disorder diagnosis; neuromuscular disorder; neuromuscular function; noninvasive diagnosis; transcranial magnetic stimulation

DESCRIPTION (provided by applicant): People with cerebral palsy have a wide variation in type and severity of motor symptoms. Current clinical classification schemes have been recognized as inadequate for prescribing therapy, and anatomical imaging has limited usefulness for the same purpose. Ideally, a non-invasive measure could be found that both correlates with motor function and is useful for predicting response to interventions such as tendon transfer and botulinum toxin injection. One of the principal methods used to study the human motor systems is transcranial magnetic stimulation (TMS), a non-invasive technique that activates the primary motor cortex. A map of a muscle's representation in motor cortex can be made by stimulation at several points on the scalp. In cerebral palsy one hemisphere may contain the maps of muscles from right and left, and the physical separation of upper and lower extremity muscles may be abnormally small. Quantification of such map abnormalities provides a new way to describe motor system pathology. In the proposed research, the geometry of limb representations will be directly measured by TMS and functional MRI. Metrics will be derived from the distance between one hemisphere's motor representations of a muscle of each limb with one of the other. The distance between muscle representations will be correlated primarily with two measures of motor functioning, the Melbourne Assessment and Gross Motor Function Measure. Anatomical brain abnormalities will be identified by conventional MRI, and used to examine the distribution of the TMS metrics within classes of brain abnormalities. Functional MRI will be used to identify areas of cortex active during movement, then compared with the TMS-derived motor maps. A control group will also be studied to provide norms for comparison. This study will lead to an understanding of motor disability in terms of representational abnormalities in the primary motor cortex. Because the TMS measurements are non-invasive, painless, and relatively rapid, this method has promise for motor general application in understanding, classifying, and treating patients with cerebral palsy.

描述（由申请人提供）：脑瘫患者运动症状的类型和严重程度存在很大差异。目前的临床分类方案已被认为不足以制定治疗方案，而解剖成像对于同一目的的用途也有限。理想情况下，可以发现一种非侵入性测量，既与运动功能相关，又可用于预测肌腱转移和肉毒毒素注射等干预措施的反应。用于研究人类运动系统的主要方法之一是经颅磁刺激（TMS），这是一种激活初级运动皮层的非侵入性技术。可以通过刺激头皮上的几个点来绘制肌肉在运动皮层中的表征图。在脑瘫中，一个半球可能包含左右肌肉的分布图，并且上肢和下肢肌肉的物理分离可能异常小。这种地图异常的量化提供了一种描述运动系统病理学的新方法。在拟议的研究中，肢体表征的几何形状将通过 TMS 和功能 MRI 直接测量。指标将从每个肢体的肌肉的一个半球的运动表征与另一半球的运动表征之间的距离得出。肌肉表征之间的距离主要与两种运动功能测量相关，即墨尔本评估和粗大运动功能测量。大脑解剖异常将通过传统 MRI 来识别，并用于检查 TMS 指标在大脑异常类别中的分布。功能性 MRI 将用于识别运动过程中皮层活跃的区域，然后与 TMS 导出的运动图进行比较。还将研究对照组以提供比较标准。这项研究将有助于从初级运动皮层的表征异常角度理解运动障碍。由于 TMS 测量是无创、无痛且相对快速的，因此该方法有望在理解、分类和治疗脑瘫患者的运动方面得到广泛应用。