Takechi Utako, Matsunaga Kaoru, Nakanishi Ryoji, Yamanaga Hiroaki, Murayama Nobuki, Mafune Kosuke, Tsuji Sadatoshi
Department of Neurology, University of Occupational and Environmental Health, School of Medicine, Japan.
Department of Neurology and Rehabilitation Medicine, Kumamoto Kinoh Hospital, Kumamoto, Japan.
Clin Neurophysiol. 2014 Oct;125(10):2055-69. doi: 10.1016/j.clinph.2014.01.034. Epub 2014 Feb 28.
A general lack of longitudinal studies on interhemispheric interactions following stroke led us to use transcranial magnetic stimulation (TMS) to examine changes in corticospinal/intracortical excitability and transcallosal inhibition over a 1-year period following subcortical stroke.
We measured TMS parameters such as motor threshold (MT), short-interval intracortical inhibition (SICI), and ipsilateral silent period (iSP) and evaluated clinical scores at three time-points (T1, T2, and T3) in 24 patients and 25 age-matched healthy subjects.
At T1, we observed reduced MTs and SICIs with prolonged iSPs in the unaffected hemisphere (UH). In contrast, increased MTs and reduced SICIs were observed in the affected hemisphere (AH). These abnormalities gradually reduced and no MEP response to TMS at T1 predicted a worse prognosis. The prolonged iSP at T1 was associated with more severe impairments, but it did not necessarily predict a worse prognosis after 1year.
UH excitability was increased at the post-acute time-period, which may have resulted in enhanced transcallosal inhibition to the AH. However, it is unclear whether there was a causal relationship between the enhanced transcallosal inhibition and the extent of clinical recovery.
This is the first study to demonstrate changes in transcallosal inhibition over a longitudinal period following stroke.
由于缺乏关于中风后半球间相互作用的纵向研究，我们采用经颅磁刺激（TMS）来检测皮质脊髓/皮质内兴奋性以及胼胝体抑制在皮质下中风后1年期间的变化。
我们测量了24例患者和25例年龄匹配的健康受试者在三个时间点（T1、T2和T3）的TMS参数，如运动阈值（MT）、短间隔皮质内抑制（SICI）和同侧静息期（iSP），并评估了临床评分。
在T1时，我们观察到未受影响半球（UH）的MT降低、SICI降低且iSP延长。相反，在受影响半球（AH）观察到MT升高和SICI降低。这些异常逐渐减轻，且在T1时对TMS无运动诱发电位反应预示着预后较差。T1时延长的iSP与更严重的损伤相关，但不一定能预测1年后的预后较差。
在急性后期，UH兴奋性增加，这可能导致对AH的胼胝体抑制增强。然而，尚不清楚增强的胼胝体抑制与临床恢复程度之间是否存在因果关系。
这是第一项证明中风后纵向期间胼胝体抑制变化的研究。
