1University of Surrey, Guildford, UK.
Neurorehabil Neural Repair. 2014 May;28(4):335-43. doi: 10.1177/1545968313510972. Epub 2013 Dec 11.
Initial evidence suggests that the integrity of the ipsilesional corticospinal tract (CST) after stroke is strongly related to motor function in the chronic state but not the treatment gain induced by motor rehabilitation.
We examined the association of motor status and treatment benefit by testing patients with a wide range of severity of hemiparesis of the left and right upper extremity.
Diffusion tensor imaging was performed in 22 patients beyond 12 months after onset of stroke with severe to moderate hemiparesis. Motor function was tested before and after 2 weeks of modified constraint-induced movement therapy.
CST integrity, but not lesion volume, correlated with the motor ability measures of the Wolf Motor Function Test and the Motor Activity Log. No differences were found between left and right hemiparesis. Motor performance improved significantly with the treatment regime, and did so equally for patients with left and right arm paresis. However, treatment benefit was not associated with either CST integrity or lesion volume.
CST integrity correlated best in this small trial with chronic long-term status but not treatment-induced improvements. The CST may play a different role in the mechanisms mediating long-term outcome compared to those underlying practice-induced gains after a chronic plateau in motor function.
初步证据表明，中风后健侧皮质脊髓束（CST）的完整性与慢性状态下的运动功能密切相关，但与运动康复引起的治疗获益无关。
我们通过测试左侧和右侧上肢轻偏瘫程度不同的患者，检验运动状态和治疗获益之间的关联。
对 22 例发病后 12 个月以上、轻至中度偏瘫的患者进行弥散张量成像。在 2 周的改良强制性运动疗法前后对患者进行运动功能测试。
CST 完整性，而不是病变体积，与 Wolf 运动功能测试和运动活动日志的运动能力测量值相关。左侧和右侧偏瘫之间没有差异。运动表现随着治疗方案显著改善，且对左、右臂瘫痪的患者效果相同。然而，治疗获益与 CST 完整性或病变体积无关。
在这项小型试验中，CST 完整性与慢性长期状态相关性最佳，而与治疗引起的改善无关。与慢性运动功能平台期后实践诱导收益的机制相比，CST 在介导长期结局的机制中可能发挥不同的作用。
