Ciccarelli O, Toosy A T, Marsden J F, Wheeler-Kingshott C M, Miller D H, Matthews P M, Thompson A J
Department of Headache, Brain Injury and Neurorehabilitation, Institute of Neurology, University College London, London, UK.
J Neurol. 2006 Jul;253(7):882-91. doi: 10.1007/s00415-006-0125-z. Epub 2006 Apr 20.
Patients with multiple sclerosis (MS) activate a more diffuse cortical network than do healthy subjects when they perform motor tasks. This brain functional reorganisation might contribute to the limiting of disability, but it is unclear whether there is a loss of regional activation in more advanced disease. The aim of this study was to assess whether functional reorganisation diminishes in more disabled patients with primary progressive (PP) MS. The differences in the fMRI response to active and passive movements of the dominant ankle of 13 patients and 16 controls were assessed. The relationships between functional activation and disability and brain lesion load and atrophy were investigated.Patients showed greater fMRI activation than controls with passive movements in the superior temporal gyrus, rolandic operculum, and putamen. The fMRI response to active and passive movements in the ipsilateral inferior frontal gyrus was lower in patients with greater disability and greater brain T2 lesion load, respectively. Furthermore, the fMRI activation with active movements in the contralateral cerebellum was lower in patients with worse mobility. The increased activity with passive movements in regions that participate in sensori-motor integration, such as the putamen, reflects true functional reorganisation, since passive movements induce brain activation through sensory afferents only. The inverse correlation between the fMRI response in regions that are associated with motor control, and clinical or MRI measures of disease progression, suggests that there is a loss of distributed activation in more disabled patients. This may inform future treatment strategies.
与健康受试者相比，患有多发性硬化症（MS）的患者在执行运动任务时会激活更广泛的皮质网络。这种大脑功能重组可能有助于限制残疾，但尚不清楚在疾病进展更严重时是否存在局部激活丧失的情况。本研究的目的是评估在原发性进行性（PP）MS病情更严重的患者中，功能重组是否会减弱。评估了13例患者和16名对照者优势踝主动和被动运动的功能磁共振成像（fMRI）反应差异。研究了功能激活与残疾、脑病变负荷和萎缩之间的关系。患者在颞上回、中央沟盖和壳核被动运动时的fMRI激活程度高于对照者。在残疾程度更高和脑T2病变负荷更大的患者中，同侧额下回对主动和被动运动的fMRI反应分别较低。此外，在活动能力较差的患者中，对侧小脑主动运动时的fMRI激活程度较低。壳核等参与感觉运动整合区域被动运动时活动增加反映了真正的功能重组，因为被动运动仅通过感觉传入诱导大脑激活。与运动控制相关区域的fMRI反应与疾病进展的临床或MRI测量之间的负相关表明，病情更严重的患者存在分布式激活丧失的情况。这可能为未来的治疗策略提供参考。
