Prediction of Motor Function Recovery after Subcortical Stroke: Case Series of Activation PET and TMS Studies.
Prediction of Motor Function Recovery after Subcortical Stroke: Case Series of Activation PET and TMS Studies.
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DOI：
10.5535/arm.2012.36.4.501
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发表时间：
2012-08
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影响因子：
--
通讯作者：
Paik NJ
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文献类型：
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作者：
Jung SH;Kim YK;Kim SE;Paik NJ
检查运动任务诱导的大脑激活模式和经颅磁刺激（TMS）的运动反应是否对中风后的运动恢复具有预后意义。10例首次皮质下卒中患者（55.7±17.3岁，5例缺血性和5例出血性）在卒中后37.7±25.2天在不同条件下（1：休息，2：特定运动任务激活）接受了2次FDG PET研究。在激活和休息期间，在减影图像上显示葡萄糖代谢增加超过10%的区域被认为是显著激活的。皮质内抑制（ICI）和皮质内易化（ICF）的皮质兴奋性进行了评估，使用TMS从两个拇短展肌在7天内的PET扫描。在神经平台点评估运动功能恢复。运动反应的存在下，在瘫痪的网站TMS和正常的皮质内抑制，并促进模式在未受影响的半球被认为是有关良好的恢复。还观察到PET上的同病灶激活与良好的运动恢复之间的关联，但这显著弱于TMS测量的皮质兴奋性与运动恢复之间的关联。同侧皮质脊髓通路的完整性，正常化的对侧皮质内兴奋性，以及同侧半球的任务相关激活被发现预测中风后运动恢复显着。
To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke. Ten patients with first-ever subcortical stroke (55.7±17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7±25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau. The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facilitation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery. Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery significantly.