Carey Leeanne M, Abbott David F, Lamp Gemma, Puce Aina, Seitz Rüdiger J, Donnan Geoffrey A
La Trobe University, Bundoora, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
Neurorehabil Neural Repair. 2016 Nov;30(10):988-1000. doi: 10.1177/1545968316653836. Epub 2016 Jun 20.
The brain may reorganize to optimize stroke recovery. Yet relatively little is known about neural correlates of training-facilitated recovery, particularly after loss of body sensations.
Our aim was to characterize changes in brain activation following clinically effective touch discrimination training in stroke patients with somatosensory loss after lesions of primary/secondary somatosensory cortices or thalamic/capsular somatosensory regions using functional magnetic resonance imaging (fMRI).
Eleven stroke patients with somatosensory loss, 7 with lesions involving primary (S1) and/or secondary (S2) somatosensory cortex (4 male, 58.7 ± 13.3 years) and 4 with lesions primarily involving somatosensory thalamus and/or capsular/white matter regions (2 male, 58 ± 8.6 years) were studied. Clinical and MRI testing occurred at 6 months poststroke (preintervention), and following 15 sessions of clinically effective touch discrimination training (postintervention).
Improved touch discrimination of a magnitude similar to previous clinical studies and approaching normal range was found. Patients with thalamic/capsular somatosensory lesions activated preintervention in left ipsilesional supramarginal gyrus, and postintervention in ipsilesional insula and supramarginal gyrus. In contrast, those with S1/S2 lesions did not show common activation preintervention, only deactivation in contralesional superior parietal lobe, including S1, and cingulate cortex postintervention. The S1/S2 group did, however, show significant change over time involving ipsilesional precuneus. This change was greater than for the thalamic/capsular group (P = .012; d = -2.43; CI = -0.67 to -3.76).
Different patterns of change in activation are evident following touch discrimination training with thalamic/capsular lesions compared with S1/S2 cortical somatosensory lesions, despite common training and similar improvement.
大脑可能会进行重组以优化中风恢复。然而，对于训练促进恢复的神经关联，尤其是在身体感觉丧失后，人们了解得相对较少。
我们的目的是使用功能磁共振成像（fMRI）来描述原发性/继发性体感皮层或丘脑/囊体感区域受损后出现体感丧失的中风患者在进行临床有效的触觉辨别训练后大脑激活的变化。
对11名有体感丧失的中风患者进行了研究，其中7名患者的病变累及初级（S1）和/或次级（S2）体感皮层（4名男性，年龄58.7±13.3岁），4名患者的病变主要累及体感丘脑和/或囊/白质区域（2名男性，年龄58±8.6岁）。在中风后6个月（干预前）以及进行15次临床有效的触觉辨别训练后（干预后）进行了临床和MRI测试。
发现触觉辨别能力有了与先前临床研究相似程度的改善，且接近正常范围。丘脑/囊体感病变患者在干预前激活了左侧同病灶的缘上回，干预后激活了同病灶的岛叶和缘上回。相比之下，S1/S2病变患者在干预前未显示出共同激活，仅在对侧顶上叶（包括S1）和干预后的扣带回皮层出现失活。然而，S1/S2组确实显示出随时间推移同侧楔前叶有显著变化。这种变化比丘脑/囊组更大（P = 0.012；d = -2.43；CI = -0.67至-3.76）。
尽管进行了共同的训练且改善情况相似，但与S1/S2皮层体感病变相比，丘脑/囊病变患者在进行触觉辨别训练后激活变化的模式明显不同。
