Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta T2N1N4, Canada.
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada.
Clin Neurophysiol. 2018 Feb;129(2):397-405. doi: 10.1016/j.clinph.2017.11.016. Epub 2017 Nov 26.
Brain stimulation and constraint therapy may enhance function after perinatal stroke but mechanisms are unknown. We characterized interhemispheric interactions (IHI) in hemiparetic children and explored their relationship to motor function and neuromodulation.
Forty-five hemiparetic perinatal stroke subjects aged 6-19 years completed a clinical trial of repetitive-transcranial magnetic stimulation (rTMS) and constraint therapy. Paired-pulse TMS measured IHI in cases and normal controls. Suprathreshold conditioning stimuli preceded contralateral test stimuli bidirectionally: stroke to non-stroke (SNS) and non-stroke to stroke (NSS). Primary outcome was the interhemispheric ratio (IHR) between conditioned and test only MEP amplitudes X100 (<100 implied inhibition). Motor outcomes at baseline and post-intervention were compared to IHR.
Procedures were well tolerated. IHI occurred bidirectionally in controls. Eighteen stroke participants had complete data. IHR were increased in stroke participants in both directions. SNS IHR was >100 (facilitation) in 39% of measurements and correlated with better motor function. NSS IHR correlated with poorer motor function. Intervention-induced clinical change was not associated with IHR.
Interhemispheric interactions are altered and related to clinical function, but not necessarily neuromodulation, in children with perinatal stroke.
Adding interhemispheric interactions to evolving models of developmental plasticity following early injury may advance neuromodulation strategies.
脑刺激和约束疗法可能会增强围产期卒中后的功能，但机制尚不清楚。我们描述了偏瘫儿童的大脑半球间相互作用（IHI），并探讨了其与运动功能和神经调节的关系。
45 名年龄在 6-19 岁的偏瘫围产期卒中患者完成了重复经颅磁刺激（rTMS）和约束治疗的临床试验。成对脉冲 TMS 测量了病例和正常对照组的 IHI。阈上刺激条件刺激一前向地引发对侧测试刺激：卒中到非卒中（SNS）和非卒中到卒中（NSS）。主要结果是条件和仅测试 MEP 振幅的大脑半球间比（IHR）×100（<100 表示抑制）。将基线和干预后的运动结果与 IHR 进行比较。
程序均能良好耐受。对照组的 IHI 发生在双向。18 名卒中参与者有完整的数据。在两个方向上，卒中参与者的 IHR 均增加。SNS IHR 在 39%的测量中>100（易化），与更好的运动功能相关。NSS IHR 与较差的运动功能相关。干预引起的临床变化与 IHR 无关。
偏瘫儿童的大脑半球间相互作用发生改变，并与临床功能相关，但与神经调节不一定相关。
将大脑半球间相互作用添加到早期损伤后发育可塑性的不断发展的模型中，可能会推进神经调节策略。
