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的差异。目前的临床分类方案已被公认为不足以处方治疗，解剖成像具有有限的用途，用于相同的目的。理想情况下，可以找到一种非侵入性的测量方法，既与运动功能相关，又可用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。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。通过刺激头皮上的几个点，可以绘制出运动皮层中肌肉代表的地图。大脑性麻痹患者的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。量化这种地图异常提供了一种新的方式来描述运动系统的病理。在拟议的研究中，肢体代表的几何形状将直接测量TMS和功能MRI。将从每个肢体的一个半球的肌肉运动表征与另一个之间的距离导出。肌肉表征之间的距离将主要与运动功能的两个测量值相关，即墨尔本评估和粗大运动功能测量。将通过常规MRI识别解剖脑异常，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层区域，然后与TMS衍生的运动图进行比较。还将研究一个对照组，以提供比较标准。这项研究将导致在初级运动皮层的代表性异常的运动残疾的理解。由于TMS测量是非侵入性的，无痛的，并且相对快速，因此该方法在理解，分类和治疗脑瘫患者的运动一般应用中具有前景。

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.