肉毒毒素调节脑卒中后痉挛性偏瘫的皮质适应不良。
Botulinum toxin modulates cortical maladaptation in post-stroke spasticity.
机构信息
Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Barker Street, Randwick, New South Wales 2031, Australia.
出版信息
Muscle Nerve. 2013 Jul;48(1):93-9. doi: 10.1002/mus.23719. Epub 2013 Apr 29.
INTRODUCTION
Maladaptive plasticity involving the unaffected hemisphere (UH) in stroke patients may contribute to post-stroke deficits, including spasticity. We investigated the central and peripheral effects of botulinum toxin in post-stroke spasticity to determine whether there is modulation of cortical processes in the UH.
METHODS
Transcranial magnetic stimulation and peripheral nerve excitability studies were undertaken in 5 stroke patients with upper limb spasticity before (T1) and 6 weeks after (T2) botulinum injection.
RESULTS
Transcranial magnetic stimulation demonstrated inexcitable motor cortices of the affected hemisphere at T1 and T2, and short-interval intracortical inhibition (SICI) in the UH was significantly reduced at T1. At T2, SICI in the UH increased significantly compared with T1, normalizing to controls, and was found to be associated with clinical improvements in spasticity. Peripheral excitability parameters were unchanged after injection.
CONCLUSION
Cortical excitability changes were demonstrated in UH, suggesting that the clinical benefits of botulinum toxin relate to modulation of abnormal central reorganization (maladaptive plasticity) in post-stroke spasticity.
简介
脑卒中患者未受损半球（UH）的适应不良性可塑性可能导致卒中后缺损，包括痉挛。我们研究了肉毒毒素对卒中后痉挛的中枢和外周作用，以确定 UH 中是否存在皮质过程的调节。
方法
对 5 例上肢痉挛的脑卒中患者在（T1）和（T2）肉毒毒素注射后 6 周进行经颅磁刺激和周围神经兴奋性研究。
结果
T1 和 T2 时，受影响半球的经颅磁刺激显示运动皮质不可兴奋，而 UH 的短间隔皮质内抑制（SICI）在 T1 时明显降低。T2 时，与 T1 相比，UH 中的 SICI 显著增加，与对照组正常化，并与痉挛的临床改善相关。注射后外周兴奋性参数无变化。
结论
在 UH 中观察到皮质兴奋性变化，表明肉毒毒素的临床益处与调节卒中后痉挛中的异常中枢重组（适应不良性可塑性）有关。
Zotero 插件