Motor-Functional Neuroanatomy in Cerebral Palsy

描述（由申请人提供）：脑瘫患者在运动症状的类型和严重程度上有很大差异。目前的临床分类方案已被认为是不充分的处方治疗，解剖成像在同一目的的有用性有限。理想情况下，一种非侵入性的测量方法可以发现既与运动功能相关，又有助于预测对肌腱转移和肉毒杆菌毒素注射等干预措施的反应。研究人体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。通过刺激头皮上的几个点，可以绘制出肌肉在运动皮层中的分布图。在脑瘫中，一个半球可能包含左右两侧的肌肉分布图，上肢和下肢肌肉的物理分离可能异常小。这种图谱异常的量化提供了一种描述运动系统病理的新方法。在本研究中，肢体表征的几何形状将通过TMS和功能性MRI直接测量。度量将从每个肢体肌肉的一个半球的运动表征与另一个半球的运动表征之间的距离导出。肌肉表征之间的距离将主要与运动功能的两种测量相关联，墨尔本评估和大运动功能测量。解剖性脑异常将通过常规MRI识别，并用于检查脑异常类别内TMS指标的分布。功能性MRI将用于识别运动过程中活跃的皮质区域，然后与tms衍生的运动图进行比较。还将研究一个控制组，以提供比较标准。本研究将从初级运动皮层的表征性异常的角度来理解运动障碍。由于TMS测量是非侵入性的、无痛的、相对快速的，因此该方法有望在理解、分类和治疗脑瘫患者方面得到广泛应用。

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.