Tang Qing, Li Guangming, Liu Tao, Wang Anguo, Feng Shenggang, Liao Xiang, Jin Yu, Guo Zhiwei, He Bin, McClure Morgan A, Xing Guoqiang, Mu Qiwen
Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University, Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong 637000, Sichuan, China.
Department of Oncology, North Sichuan Medical University, Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong 637000, Sichuan, China.
Neurosci Biobehav Rev. 2015 Oct;57:392-400. doi: 10.1016/j.neubiorev.2015.09.003. Epub 2015 Sep 5.
Functional magnetic resonance imaging (fMRI) studies suggest that stroke-induced motor deficits are associated with an interhemispheric imbalance of motor activation. This meta-analysis aims to determine the changes of interhemispheric activation balance (IHAB) in motor-related cortices along with post-stroke motor recovery.
We searched PubMed for fMRI studies that investigated IHAB in stroke patients with motor recovery. Laterality indexes (LIs, (ipsilesional activation-contralesional activation)/(ipsilesional activation+contralesional activation)) before and after motor improvement were extracted as the outcome measures of IHAB. Data were synthesized by calculating standardized mean difference (SMD, Hedges' adjusted g) with 95% confidence intervals (CI).
After the rejection of 459 studies, 22 trials fulfilled the inclusion criteria and were included in the systematic review and meta-analysis. The LIs of sensorimotor cortex (SMC, 22 trials, 195 subjects), premotor cortex (PMC, 12 trials, 93 subjects), supplementary motor area (SMA, 12 trials, 92 subjects), and cerebellum (CB, 4 trials, 31 subjects) were assessed. Studies sampling from stroke patients with motor improvement showed positive changes of LI in SMC (SMD, 0.71; 95% CI, 0.41-1.01; P<0.00001) and PMC (SMD, 0.68; 95% CI, 0.36-1.00; P<0.0001), but not in SMA (SMD, 0.07; 95% CI, -0.62 to 0.75; P=0.85) and CB (SMD, -0.17; 95% CI, -1.52 to 1.19, P=0.81). Studies involving stroke patients with poor motor recovery showed non-significant changes in all of the four motor-related cortices (P>0.05).
This meta-analysis suggests that along with good motor recovery of stroke patients, the IHAB is up-regulated in SMC and PMC, but not significantly changed in SMA and CB. Because of the limited data, further studies are needed to verify the findings.
功能磁共振成像（fMRI）研究表明，中风引起的运动功能障碍与运动激活的半球间失衡有关。本荟萃分析旨在确定中风后运动恢复过程中运动相关皮层的半球间激活平衡（IHAB）的变化。
我们在PubMed上搜索了研究中风后运动恢复患者IHAB的fMRI研究。提取运动改善前后的偏侧性指数（LIs，（患侧激活-对侧激活）/（患侧激活+对侧激活））作为IHAB的结果指标。通过计算标准化平均差（SMD，Hedges校正g）及其95%置信区间（CI）来综合数据。
在排除459项研究后，22项试验符合纳入标准，并被纳入系统评价和荟萃分析。评估了感觉运动皮层（SMC，22项试验，195名受试者）、运动前区皮层（PMC，12项试验，93名受试者）、辅助运动区（SMA，12项试验，92名受试者）和小脑（CB，4项试验，31名受试者）的LIs。对中风后运动改善患者的研究显示，SMC（SMD，0.71；95%CI，0.41-1.01；P<0.00001）和PMC（SMD，0.68；95%CI，0.36-1.00；P<0.0001）的LI有正向变化，但SMA（SMD，0.07；95%CI，-0.62至0.75；P=0.85）和CB（SMD，-0.17；95%CI，-1.52至1.19，P=0.81）没有。对中风后运动恢复较差患者的研究显示，所有四个运动相关皮层均无显著变化（P>0.05）。
本荟萃分析表明，随着中风患者运动功能的良好恢复，SMC和PMC中的IHAB上调，但SMA和CB中无显著变化。由于数据有限，需要进一步研究来验证这些发现。
