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

在美国，中风是一个日益严重的心血管问题，大约有700万人报告说 中风事件。中风在南得克萨斯州里奥格兰德山谷是一个特别令人担忧的问题，那里的发病率 大约3.8%(相比之下，总人口为0.27%)。中风后的常见限制包括： 步态不稳、上肢瘫痪、感觉障碍、疼痛、抑郁和认知障碍。最重要的是 上肢和下肢的损伤和瘫痪仍然是最常见的。康复策略可以 改善中风幸存者的上肢和下肢活动能力。然而，不幸的是，大多数康复 治疗策略采用“一刀切”的方法，从而限制了在异质性中风人群中的疗效。 为了解决这一局限性，生物标志物的使用已经成为通知患者选择治疗的一种手段 不同的康复方法。 总的来说，生物标记物主要关注皮质脊髓束结构或功能的变化如何影响。 恢复。总体而言，已发表的研究表明，大脑中皮质脊髓束通路的变化 可能会影响中风患者的功能恢复。然而，目前的康复方法是针对 备用的皮质脊髓通路在患者群体中的疗效有限，特别是那些严重的 减损。因此，了解皮质脊髓束以外的其他途径可能会影响到什么，这是至关重要的。 以期更好地指导中风患者的临床治疗。 在这里，我们建议评估患者交替感觉运动通路退变的进展。 对于中风，通过对感觉运动通路分叉的脑干和脊髓进行成像。评估 我们的前提是，我们将在30名急性脑缺血患者中进行一项纵向、重复测量的临床研究 卒中。我们将评估颈、胸和腰椎的感觉运动通路神经退行性变。 通过收集磁共振成像(MRI)和弥散加权成像(DWI)在脊髓和脑干中进行 在中风后2周、12周和24周。神经成像也将在10个年龄匹配的人中收集 健康对照组。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 干细胞和(2)脊髓，(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 在首次中风后进展，并将影响受损和非受损的大脑半球通路 严重影响运动功能。 我们的研究结果将为评估替代方案的更大规模的临床试验提供基础 感觉运动通路退行性变。此外，我们的工作将提供是否有治疗选择的框架 急性卒中患者应考虑以替代感觉运动通路为靶点。

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.