Werhahn Konrad J, Conforto Adriana B, Kadom Nadja, Hallett Mark, Cohen Leonardo G
Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
Ann Neurol. 2003 Oct;54(4):464-72. doi: 10.1002/ana.10686.
It has been proposed that the intact (ipsilateral) motor cortex play a significant role mediating recovery of motor function in the paretic hand of chronic stroke patients, but this hypothesis has not been tested experimentally. Here, we evaluated the effects of transcranial magnetic stimulation (TMS) on motor performance of the paretic hand of chronic stroke patients and healthy controls. We hypothesized that, if activity in the intact hemisphere contributes to functional recovery, TMS should result in abnormal motor behavior in the paretic hand. We found that stimulation of the intact hemisphere resulted in delayed simple reaction times (RTs) in the contralateral healthy but not in the ipsilateral paretic hand, whereas stimulation of the lesioned hemisphere led to a marked delay in RT in the contralateral paretic hand but not in the ipsilateral healthy hand. RT delays in the paretic hand correlated well with functional recovery. Finger tapping in the paretic hand was affected by TMS of the lesioned but not the intact hemisphere. These results are consistent with the idea that recovered motor function in the paretic hand of chronic stroke patients relies predominantly on reorganized activity within motor areas of the affected hemisphere.
有人提出，完整的（同侧）运动皮层在介导慢性中风患者患侧手运动功能恢复中起重要作用，但这一假设尚未得到实验验证。在此，我们评估了经颅磁刺激（TMS）对慢性中风患者患侧手及健康对照者运动表现的影响。我们假设，如果完整半球的活动有助于功能恢复，那么TMS应会导致患侧手出现异常运动行为。我们发现，刺激完整半球会使对侧健康手的简单反应时间（RT）延迟，而患侧手则不会；而刺激受损半球会使对侧患侧手的RT显著延迟，同侧健康手则不会。患侧手的RT延迟与功能恢复密切相关。患侧手的手指敲击受受损半球而非完整半球的TMS影响。这些结果与以下观点一致，即慢性中风患者患侧手恢复的运动功能主要依赖于患侧半球运动区域内重新组织的活动。
