Role of Alternate Sensorimotor Pathway Degeneration in Motor Function in Acute Stroke

交替感觉运动通路退化在急性中风运动功能中的作用

• 批准号: 10439241
• 负责人: Kelsey Potter-Baker
• 金额: $ 44.4万
• 依托单位: UNIVERSITY OF TEXAS RIO GRANDE VALLEY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10439241
• 关键词: Acute; Address; Affect; Age; Anatomy; Animals; Autopsy; Biological Markers; Brachial Paresis; Brain; Brain Stem; Brain region; Cardiovascular system; Cerebral Infarction; Cerebral hemisphere; Cervical; Chest; Chronic; Chronic Phase; Clinical Research; Clinical Treatment; Clinical Trials; Corticospinal Tracts; Cross-Sectional Studies; Data; Diffusion Magnetic Resonance Imaging; Evaluation; Gait; General Population; Gliosis; Human; Image; Impaired cognition; Impairment; Incidence; Individual; Infarction; Ischemic Stroke; Knowledge; Lesion; Lower Extremity; Lumbar Regions; Lumbar spinal cord structure; Magnetic Resonance Imaging; Maps; Measures; Mental Depression; Middle Cerebral Artery Infarction; Motor; Nerve Degeneration; Neurites; Pain; Paralysed; Paresis; Pathway interactions; Patient Selection; Patients; Pilot Projects; Population; Publishing; Pyramidal Tracts; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Role; Sensory; Side; South Texas; Spinal Cord; Stroke; Structure; Substantia nigra structure; Techniques; Thalamic structure; Time; United States; Upper Extremity; Work; acute stroke; axonal degeneration; base; density; improved; motor impairment; neuroimaging; neuroinflammation; neuron loss; neuroregulation; patient population; post stroke; potential biomarker; rehabilitation strategy; reticulospinal tract; statistics; stroke event; stroke patient; stroke recovery; stroke survivor

Stroke is a growing cardiovascular concern in the United States, with approximately 7 million individuals reporting a stroke event. Stroke is a particular concern in the South Texas Rio Grande Valley, where incidence is approximately 3.8% (compared to 0.27% in the general population). Common limitations after a stroke include: gait instability, upper limb paralysis, sensory deficits, pain, depression and cognitive impairments. Of all impairments, paresis of the upper and lower limb remains the most common. Rehabilitation strategies can improve upper and lower limb mobility in stroke survivors. Unfortunately, though, the majority of rehabilitation strategies employ a ‘one-size-fits-all’ approach, thereby limiting efficacy in the heterogenous stroke population. To address this limitation, the use of biomarkers has emerged as a means to inform patient selection for the differing rehabilitation approaches. In general, biomarkers have focused on how changes in corticospinal tract structure or function influence recovery. Overall, published work has suggested that changes to the corticospinal tract pathways in the brain may influence functional recovery in patients with stroke. However, current rehabilitation approaches targeting spared corticospinal pathways have had limited efficacy in patient populations, particularly those with severe impairments. Therefore, it is vital to understand what other pathways beyond the corticospinal tract may influence functional recovery as to better inform clinical treatment of patients with stroke. Here, we propose to evaluate the progression of alternate sensorimotor pathway degeneration in patients with stroke by imaging the brainstem and spinal cord, where the sensorimotor pathways diverge. To evaluate our premise, we will perform a longitudinal, repeated-measures clinical study in 30 subjects with acute ischemic stroke. We will evaluate sensorimotor pathway neurodegeneration in the cervical, thoracic and lumbar spinal cord and in the brainstem by collecting magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) at two-, twelve- and twenty-four weeks post-stroke. Neuroimaging will also be collected in 10 age-matched healthy controls. Our aims will: (1) evaluate alternate sensorimotor pathway neurodegeneration in the brain stem and (2) spinal cord and (3) determine how neurodegeneration affects motor function and impairment in acute stroke patients. Our central hypothesis is that degeneration of the alternate sensorimotor pathways is progressive after a first-time stroke and will affect both the lesioned and non-lesioned hemisphere pathways to significantly impact motor function. The results from our study will provide the basis for larger-scale clinical trials evaluating alternate sensorimotor pathway degeneration. Further, our work will provide the framework for whether treatment options targeting alternate sensorimotor pathways should be considered in populations with acute stroke.

在美国，中风是一种日益严重的心血管疾病，约有700万人报告 中风事件中风在德克萨斯州南部的格兰德河流域是一个特别令人关注的问题， 约3.8%（与一般人群的0.27%相比）。中风后常见的限制包括： 步态不稳、上肢瘫痪、感觉缺陷、疼痛、抑郁和认知障碍。所有 在残疾方面，上肢和下肢的麻痹仍然是最常见的。康复策略可以 改善中风幸存者上肢和下肢活动能力。不幸的是，大多数的康复治疗 这些策略采用“一刀切”的方法，从而限制了在异质性卒中人群中的疗效。 为了解决这一局限性，生物标志物的使用已经成为告知患者选择的一种手段。 不同的康复方法。 一般来说，生物标志物集中在皮质脊髓束结构或功能的变化如何影响 复苏总的来说，已发表的研究表明，大脑皮质脊髓束通路的变化 可能影响中风患者的功能恢复。然而，目前的康复方法针对 备用皮质脊髓通路在患者人群中的疗效有限，特别是那些患有严重 损伤因此，了解皮质脊髓束以外的其他通路可能影响 功能恢复，以便更好地为中风患者的临床治疗提供信息。 在这里，我们建议评估患者交替感觉运动通路变性的进展情况， 通过对感觉运动通路分叉的脑干和脊髓进行成像来治疗中风。评价 我们的前提是，我们将在30例急性缺血性脑卒中患者中进行纵向、重复测量的临床研究。 中风我们将评估感觉运动通路神经退行性病变在颈椎，胸椎和腰椎 脊髓和脑干的磁共振成像（MRI）和弥散加权成像（DWI） 分别在中风后第2周、第12周和第24周。还将收集10名年龄匹配的 健康对照我们的目标是：（1）评估大脑中交替感觉运动通路的神经变性 干和（2）脊髓和（3）确定神经变性如何影响运动功能和损伤， 急性中风患者。我们的中心假设是交替感觉运动通路的退化是 在首次中风后进行性，并将影响病变和非病变半球通路， 严重影响运动功能。 我们的研究结果将为更大规模的临床试验提供基础， 感觉运动通路退化此外，我们的工作将提供一个框架， 在急性卒中人群中应考虑靶向替代感觉运动通路。