Juenger H, Linder-Lucht M, Walther M, Berweck S, Mall V, Staudt M
Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
Neuropediatrics. 2007 Jun;38(3):130-6. doi: 10.1055/s-2007-985904.
The aim of this study was to assess neuromodulative effects of CIMT in congenital hemiparesis.
Ten patients (age range: 10-30 years) with congenital hemiparesis due to unilateral cortico-subcortical infarctions in the middle cerebral artery territory, and with preserved cortico-spinal projections from the affected hemisphere to the paretic hand, were included. After a twelve-day period of constraint-induced movement therapy (CIMT), all showed a significant improvement of paretic hand function. Immediately before and after therapy, functional MRI during active and passive hand movements was performed to monitor cortical activation.
Four patients showed consistent increases in cortical activation during movements of the paretic hand in the primary sensorimotor cortex of the affected hemisphere. Of the remaining six patients, three showed similar changes, but these results were potentially contaminated by an improved task performance after therapy. No significant alteration in activation was observed in two patients, and one showed movement artifacts.
Even a short period of CIMT can induce changes of cortical activation in congenital hemiparesis. In our sample, increases in fMRI activation were consistently observed in the primary sensorimotor cortex of the affected hemisphere. Thus, the potential for neuromodulation is preserved in the affected hemisphere after early brain lesions.
本研究旨在评估强制性诱导运动疗法（CIMT）对先天性偏瘫的神经调节作用。
纳入10例患者（年龄范围：10 - 30岁），这些患者因大脑中动脉区域单侧皮质 - 皮质下梗死导致先天性偏瘫，且患侧半球至瘫痪手的皮质脊髓投射保留。在进行为期12天的强制性诱导运动疗法（CIMT）后，所有患者瘫痪手功能均有显著改善。在治疗前后即刻，在主动和被动手部运动期间进行功能磁共振成像以监测皮质激活情况。
4例患者在患侧半球初级感觉运动皮质中瘫痪手运动期间皮质激活持续增加。其余6例患者中，3例表现出类似变化，但这些结果可能受到治疗后任务表现改善的影响。2例患者未观察到激活有明显改变，1例出现运动伪影。
即使是短时间的CIMT也可诱导先天性偏瘫患者皮质激活发生变化。在我们的样本中，在患侧半球初级感觉运动皮质中持续观察到功能磁共振成像激活增加。因此，早期脑损伤后，患侧半球仍保留神经调节潜力。
