Pantano Patrizia, Mainero Caterina, Lenzi Delia, Caramia Francesca, Iannetti Gian Domenico, Piattella Maria Cristina, Pestalozza Isabella, Di Legge Silvia, Bozzao Luigi, Pozzilli Carlo
Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.
Brain. 2005 Sep;128(Pt 9):2146-53. doi: 10.1093/brain/awh549. Epub 2005 May 18.
Using functional MRI (fMRI), patients with multiple sclerosis showed a greater extent of motor activation than controls. Although functional changes are often interpreted as adaptive and as a contributing factor in limiting the clinical deficit, no longitudinal studies have yet been performed for multiple sclerosis. Sixteen patients with multiple sclerosis, two patients with possible multiple sclerosis and nine age-matched controls underwent two fMRI studies with a time interval of 15-26 months. The motor task consisted of a self-paced sequential finger opposition movement with the right hand. Patients with multiple sclerosis exhibited greater bilateral activation than controls in both fMRI studies. At follow-up, patients showed a reduction in functional activity in the ipsilateral sensorimotor cortex and in the contralateral cerebellum. No significant differences between the two fMRI studies were observed in controls. Activation changes in ipsilateral motor areas correlated inversely with age, extent and progression of T1 lesion load, and occurrence of a new relapse. This study may help the understanding of the evolution of brain plastic changes in multiple sclerosis indicating that, in younger patients with a less structural brain damage and benign clinical course, the brain reorganizes its functional activity towards a more lateralized pattern of brain activation. The tendency towards a normalization of brain functional activity is hampered in older patients and in those developing relapses or new irreversible brain damage.
使用功能磁共振成像（fMRI）技术，多发性硬化症患者比对照组表现出更大程度的运动激活。尽管功能变化通常被解释为适应性变化且是限制临床缺陷的一个促成因素，但尚未对多发性硬化症进行纵向研究。16例多发性硬化症患者、2例可能患有多发性硬化症的患者以及9例年龄匹配的对照组接受了两次fMRI研究，时间间隔为15至26个月。运动任务包括右手自主节奏的顺序手指对指运动。在两项fMRI研究中，多发性硬化症患者均比对照组表现出更大的双侧激活。随访时，患者同侧感觉运动皮层和对侧小脑的功能活动有所减少。对照组的两项fMRI研究未观察到显著差异。同侧运动区域的激活变化与年龄、T1病变负荷的范围和进展以及新复发的发生呈负相关。这项研究可能有助于理解多发性硬化症中脑可塑性变化的演变，表明在脑结构损伤较轻且临床病程良性的年轻患者中，大脑将其功能活动重新组织为更偏向一侧化的脑激活模式。在老年患者以及那些出现复发或新的不可逆脑损伤的患者中，脑功能活动正常化的趋势受到阻碍。
