Groppo Elisabetta, Baglio Francesca, Cattaneo Davide, Tavazzi Eleonora, Bergsland Niels, Di Tella Sonia, Parelli Riccardo, Carpinella Ilaria, Grosso Cristina, Capra Ruggero, Rovaris Marco
IRCCS Fondazione Don Gnocchi ONLUS, Milan, Italy.
Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo SUNY, Buffalo, NY, United States.
Front Neurol. 2017 Sep 19;8:491. doi: 10.3389/fneur.2017.00491. eCollection 2017.
A 48-year-old woman with multiple sclerosis (MS), treated with natalizumab for more than one year without clinical and magnetic resonance imaging (MRI) signs of disease activity, was diagnosed with definite progressive multifocal leukoencephalopathy (PML). She presented with subacute motor deficit of the right upper limb (UL), followed by involvement of the homolateral leg and urinary urgency. The patient was treated with steroids and plasma exchange. On follow-up MRI scans, the PML lesion remained stable and no MS rebounds were observed, but the patient complained of a progressive worsening of the right UL motor impairment, becoming dependent in most activities of daily living. A cycle of multidisciplinary rehabilitation (MDR) was then started, including daily sessions of UL robot therapy and occupational therapy. Functional MRI (fMRI) was acquired before and at the end of the MDR cycle using a motor task which consisted of 2 runs: in one run the patient was asked to observe while the second one consisted of hand grasping movements. At the end of the rehabilitation period, both the velocity and the smoothness of arm trajectories during robot-based reaching movements were significantly improved. After MDR, compared with baseline, fMRI showed significantly increased functional activation within the sensory-motor network in the active, motor task, while no significant differences were found in the observational task. MDR in MS, including robot-assisted UL training, seems to be clinically efficacious and to have a significant impact on brain functional reorganization on a short-term, even in the presence of superimposed tissue damage provoked by PML.
一名48岁的多发性硬化症（MS）女性患者，使用那他珠单抗治疗一年多，无疾病活动的临床及磁共振成像（MRI）迹象，却被诊断为确诊的进行性多灶性白质脑病（PML）。她最初表现为右上肢（UL）亚急性运动功能障碍，随后同侧腿部受累及出现尿急症状。患者接受了类固醇和血浆置换治疗。在后续的MRI扫描中，PML病灶保持稳定，未观察到MS复发，但患者抱怨右上肢运动障碍逐渐加重，在大多数日常生活活动中变得依赖他人。随后启动了一个多学科康复（MDR）周期，包括每日的上肢机器人治疗和职业治疗课程。在MDR周期开始前及结束时，使用一项由2次运行组成的运动任务进行了功能磁共振成像（fMRI）检查：一次运行中要求患者观察，另一次运行包括手部抓握动作。在康复期结束时，基于机器人的伸展运动过程中手臂轨迹的速度和平滑度均显著改善。MDR后，与基线相比，fMRI显示在主动运动任务中感觉运动网络内的功能激活显著增加，而在观察任务中未发现显著差异。MS患者的MDR，包括机器人辅助的上肢训练，似乎在临床上是有效的，并且在短期内对脑功能重组有显著影响，即使存在由PML引发的叠加组织损伤。
