Nezu A, Kimura S, Takeshita S, Tanaka M
Department of Pediatrics, Urafune Hospital of Yokohama City University School of Medicine, Yokohama, Japan.
Brain Dev. 1999 Apr;21(3):162-5. doi: 10.1016/s0387-7604(98)00094-1.
The patterns of functional recovery after unilateral cerebral damage occurring in the prenatal to infantile periods were studied in nine patients with hemiplegic cerebral palsy. Motor evoked potentials (MEPs) recorded from the small hand muscles were investigated using focal transcranial magnetic stimulation (TMS). The MEPs findings could be separated into three subtypes based on the features of ipsilateral MEPs elicited by TMS over the unaffected motor cortex. Bilateral MEPs of similar latency were obtained in three patients. These patients each having a congenital lesion invariably exhibited mirror movements and severe hemiparesis. Meanwhile, ipsilateral MEPs with markedly prolonged latency were demonstrated in two other patients, who exhibited synergistic associated movements and severe hemiparesis caused by an acquired lesion. In the remaining four patients, who showed mild hemiparesis without such abnormal interlimb coordinations, there were no ipsilateral MEPs. Thus, we suggest that TMS is useful for confirming the electrophysiological findings relevant to functional recovery in hemiplegic cerebral palsy underlying such abnormal interlimb coordinations. Specifically, bilateral MEPs of similar latency were considered consistent with compensatory mirror movements originating from bilateral motor representation in the unaffected motor cortex.
对9例偏瘫型脑瘫患者在产前至婴儿期发生单侧脑损伤后的功能恢复模式进行了研究。使用局灶性经颅磁刺激（TMS）对从小手部肌肉记录的运动诱发电位（MEP）进行了研究。根据在未受影响的运动皮层上通过TMS诱发的同侧MEP的特征，MEP的结果可分为三种亚型。在3例患者中获得了潜伏期相似的双侧MEP。这些患者均有先天性病变，均表现出镜像运动和严重偏瘫。同时，另外2例患者表现出潜伏期明显延长的同侧MEP，他们表现出协同关联运动和由后天性病变引起的严重偏瘫。其余4例患者表现为轻度偏瘫，无此类异常肢体间协调，未出现同侧MEP。因此，我们认为TMS有助于确认与偏瘫型脑瘫中此类异常肢体间协调相关的功能恢复的电生理结果。具体而言，潜伏期相似的双侧MEP被认为与源自未受影响运动皮层中双侧运动代表的代偿性镜像运动一致。
