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慢性卒中患者的运动皮层兴奋性与连接性:功能重组的多模态模型

Motor cortex excitability and connectivity in chronic stroke: a multimodal model of functional reorganization.

作者信息

Volz Lukas J, Sarfeld Anna-Sophia, Diekhoff Svenja, Rehme Anne K, Pool Eva-Maria, Eickhoff Simon B, Fink Gereon R, Grefkes Christian

机构信息

Neuromodulation and Neurorehabilitation, Max Planck Institute for Neurological Research, Gleueler Str. 50, 50931, Cologne, Germany.

出版信息

Brain Struct Funct. 2015 Mar;220(2):1093-107. doi: 10.1007/s00429-013-0702-8. Epub 2014 Jan 11.

Abstract

Cerebral ischemia triggers a cascade of cellular processes, which induce neuroprotection, inflammation, apoptosis and regeneration. At the neural network level, lesions concomitantly induce cerebral plasticity. Yet, many stroke survivors are left with a permanent motor deficit, and only little is known about the neurobiological factors that determine functional outcome after stroke. Transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI) are non-invasive approaches that allow insights into the functional (re-) organization of the cortical motor system. We here combined neuronavigated TMS, MRI and analyses of connectivity to investigate to which degree recovery of hand function depends on corticospinal tract (CST) damage and biomarkers of cerebral plasticity like cortical excitability and motor network effective connectivity. As expected, individual motor performance of 12 stroke patients with persistent motor deficits was found to depend upon the degree of CST damage but also motor cortex excitability and interhemispheric connectivity. In addition, the data revealed a strong correlation between reduced ipsilesional motor cortex excitability and reduced interhemispheric inhibition in severely impaired patients. Interindividual differences in ipsilesional motor cortex excitability were stronger related to the motor deficit than abnormal interhemispheric connectivity or CST damage. Multivariate linear regression analysis combining the three factors accounted for more than 80 % of the variance in functional impairment. The inter-relation of cortical excitability and reduced interhemispheric inhibition provides direct multi-modal evidence for the disinhibition theory of the contralesional hemisphere following stroke. Finally, our data reveal a key mechanism (i.e., the excitability-related reduction in interhemispheric inhibition) accounting for the rehabilitative potential of novel therapeutic approaches which aim at modulating cortical excitability in stroke patients.

摘要

脑缺血会引发一系列细胞过程,这些过程会诱导神经保护、炎症、细胞凋亡和再生。在神经网络层面,损伤会同时诱导大脑可塑性。然而,许多中风幸存者会留下永久性运动功能障碍,对于决定中风后功能结局的神经生物学因素却知之甚少。经颅磁刺激(TMS)和磁共振成像(MRI)是无创方法,可用于深入了解皮质运动系统的功能(再)组织。我们在此结合了神经导航TMS、MRI和连通性分析,以研究手部功能的恢复在多大程度上取决于皮质脊髓束(CST)损伤以及大脑可塑性的生物标志物,如皮质兴奋性和运动网络有效连通性。正如预期的那样,发现12名患有持续性运动功能障碍的中风患者的个体运动表现不仅取决于CST损伤程度,还取决于运动皮质兴奋性和半球间连通性。此外,数据显示,在严重受损的患者中,患侧运动皮质兴奋性降低与半球间抑制减弱之间存在很强的相关性。患侧运动皮质兴奋性的个体差异与运动功能障碍的相关性比异常的半球间连通性或CST损伤更强。结合这三个因素的多变量线性回归分析解释了功能损害差异的80%以上。皮质兴奋性与半球间抑制减弱之间的相互关系为中风后对侧半球的去抑制理论提供了直接的多模态证据。最后,我们的数据揭示了一种关键机制(即与兴奋性相关的半球间抑制减弱),这一机制解释了旨在调节中风患者皮质兴奋性的新型治疗方法的康复潜力。

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