Functional Mechanism of Neural Control in Post-Concussion Convergence Insufficiency

项目摘要/摘要：在过去的6年里，我们的研究小组研究了精神分裂症的神经机制 典型发育性会聚功能不全(TYP-CI)，儿童最常见的双眼视觉障碍 年轻人(3.4%至12.7%，5-11)导致了20-31份出版物，还有4份在审查中，6份在筹备中。 我们进行了唯一一项整合了客观眼球运动和功能磁共振结果的随机临床试验(RCT) 措施，实现100%计划招生和保留100名青壮年。28我们的结果使 与对照组相比，TYP-CI的功能活性在动眼蠕虫(OVM)和 楔子。OVM和楔区的功能活动与会聚峰值速度显著相关 第一次机械地识别这些缺陷，这些缺陷给那些受影响的人带来了巨大的负担。23 我们的纵向研究结果发现，办公室集中刺激的神经机械性变化 调节疗法(OBVAT)是一种增加额叶视野(FEF)和丘脑功能活动的疗法。 前额叶和丘脑的功能活动增加与会聚峰显著相关 速度。23，32，33 结果是导致个性化的护理点疗法来补救虚弱的 TYP-CI患者的症状。而我们的研究和其他RCT的结果表明，OBVAT是最多的 有效治疗34-36岁和34-36岁TYP-CI儿童症状和改善视功能 成人，37，38这些参与者都没有头部损伤的病史，这是一种与脑梗塞有关的病理。我们的 研究小组已经证明，CI在儿童中的患病率更高(38%到49%)，39，40和 有持续性脑震荡后症状(PPCS-CI)的成人41，42人，高于非脑震荡人群。 目前，还没有有效的治疗PPCS-CI的方法。这种发病率、发病模式的差异 (长期发作与突然发作)，病情的严重性引发了一场辩论，即 对TYP-CI有效的诊断和管理程序应用于PPCS-CI，并强烈 建议需要新的研究来优化PPCS-CI管理。我们具有得天独厚的优势 在我们建立神经功能机制的基础上，为这些问题提供答案 TYP-CI组应用TYP-CI和OBVAT。这样的研究非常重要，因为PPCS-CI是 与影响重返学校/运动、43-47岁的工作、48-51岁或开车的衰弱视觉症状有关。52 我们已经确定了在PPCS-CI治疗方面必须解决的三个重大差距，以确定其 最有效的管理。首先，鉴于病因学上的明显差异，是否存在显著差异 与客观眼动测量相关的TYP-CI和PPCS-CI之间(峰值速度，最终幅度， 和可重复性)是由于潜在的神经机制差异？第二，什么是潜在的神经？ PPCS-CI与TYP-CI的OBVAT机制比较？第三，OBVAT对PPCS-CI和IS的有效性如何 给药剂量与TYP-CI不同？这一更新解决了临床科学中的这些空白。

Project Summary/Abstract: During the past 6 years, our study team investigated the neural mechanism of typically-occurring convergence insufficiency (TYP-CI), the most common binocular vision disorder in children and young adults (3.4% to 12.7%5–11) leading to 20 publications12–31 with 4 more in review and 6 in preparation. We conducted the only randomized clinical trial (RCT) integrating objective eye movement and fMRI outcome measures, achieving 100% planned enrollment and retention of 100 young adults.28 Our results localized the reduction in functional activity for TYP-CI compared to controls within the oculomotor vermis (OVM) and the cuneus. Functional activity in the OVM and cuneus was significantly correlated to convergence peak velocity providing the first mechanistic identification of these deficits that create significant burden to those afflicted. 23 Our longitudinal results discovered that the neural mechanistic change stimulated by office-based vergence /accommodative therapy (OBVAT) is an increase in the frontal eye field (FEF) and thalamus functional activity. Increased functional activity from the FEF and thalamus significantly correlates to convergence peak velocity. 23,32,33 Results are leading to personalized point-of-care therapies remediating the debilitating symptoms for TYP-CI patients. While our research and results of other RCTs show that OBVAT is the most effective treatment for remediating symptoms and improving vision function in both TYP-CI children 34–36 and adults, 37,38 none of these participants had a history of head injury, a pathology that has been linked to CI. Our research team has demonstrated that the prevalence of CI is higher (38% to 49%) in children 39,40 and adults 41,42 with persistent post-concussive symptoms (PPCS-CI), than in the non-concussed population. Currently, there is no validated treatment for PPCS-CI. This difference in prevalence, mode of onset (longstanding versus sudden onset), and severity of the condition has led to a debate about whether the diagnostic and management procedures effective for TYP-CI should be utilized for PPCS-CI, and strongly suggests that new research is needed to optimize PPCS-CI management. We are uniquely positioned to provide answers to these questions by building on our work establishing the neurofunctional mechanism of TYP-CI and OBVAT administered to TYP-CI. Such research is of great importance because PPCS-CI is associated with debilitating visual symptoms impacting the return to school/sports, 43–47 work, 48–51 or driving. 52 We have identified three significant gaps for the treatment of PPCS-CI that must be addressed to determine its most effective management. First, given the obvious differences in etiology, are there significant differences between TYP-CI and PPCS-CI related to objective eye movement measures (peak velocity, final amplitude, and repeatability) due to underlying neural mechanistic differences? Second, what is the underlying neural mechanism of OBVAT for PPCS-CI compared to TYP-CI? Third, how effective is OBVAT for PPCS-CI and is the dosage of administration different than TYP-CI? This renewal addresses these gaps in clinical science.