Motor-Functional Neuroanatomy in Cerebral Palsy

描述(申请人提供)：脑性瘫痪患者在运动症状的类型和严重程度上有很大的差异。目前的临床分类方案已被认为不能满足处方治疗的要求，而解剖学成像在此方面的应用也有限。理想情况下，可以发现非侵入性测量既与运动功能相关，又有助于预测肌腱转移和肉毒杆菌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质的非侵入性技术。通过刺激头皮上的几个点，可以绘制出肌肉在运动皮质中的表示图。在脑性瘫痪患者中，一个半球可能包含左右两侧肌肉的地图，上肢和下肢肌肉的物理分离可能异常小。这种MAP异常的量化为描述运动系统病理提供了一种新的途径。在拟议的研究中，将通过TMS和功能磁共振直接测量肢体表示的几何形状。衡量标准将从每个肢体肌肉的一个半球的运动表示与另一个大脑半球的运动表示之间的距离得出。肌肉代表之间的距离将主要与运动功能的两个衡量标准相关，即墨尔本评估和粗大运动功能衡量。解剖脑异常将由常规MRI识别，并用于检查TMS指标在脑异常类别中的分布。功能磁共振成像将被用来识别运动过程中大脑皮质的活跃区域，然后与TMS导出的运动地图进行比较。还将对对照组进行研究，以提供比较的标准。这项研究将从初级运动皮质的表征异常的角度来理解运动障碍。由于TMS的测量是无创、无痛、相对快速的，该方法有望在理解、分类和治疗脑性瘫痪患者方面得到普遍应用。

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.