Department of Pediatrics, St. George University Hospital, Plovdiv, Bulgaria.
Department of Pediatrics and Medical Genetics, Medical University-Plovdiv, Bulgaria.
J Eval Clin Pract. 2018 Aug;24(4):839-850. doi: 10.1111/jep.12929. Epub 2018 Apr 27.
Functional magnetic resonance imaging (fMRI) is used widely to study reorganization after early brain injuries. Unilateral cerebral palsy (UCP) is an appealing model for studying brain plasticity by fMRI.
To summarize the results of task-related fMRI studies in UCP in order to get better understanding of the mechanism of neuroplasticity of the developing brain and its reorganization potential and better translation of this knowledge to clinical practice.
A systematic search was conducted on the PubMed database by keywords: "cerebral palsy", "congenital hemiparesis", "unilateral", "Magnetic resonance imaging" , "fMRI", "reorganization", and "plasticity" The exclusion criteria were as follows: case reports; reviews; studies exploring non-UCP patients; and studies with results of rehabilitation.
We found 7 articles investigated sensory tasks; 9 studies-motor tasks; 12 studies-speech tasks. Ipsilesional reorganization is dominant in sensory tasks (in 74/77 patients), contralesional-in only 3/77. In motor tasks, bilateral activation is found in 64/83, only contralesional-in 11/83, and only ipsilesional-8/83. Speech perception is bilateral in 35/51, only or dominantly ipsilesional (left-sided) in 8/51, and dominantly contralesional (right-sided) in 8/51. Speech production is only or dominantly contralesional (right-sided) in 88/130, bilateral-26/130, and only or dominantly ipsilesional (left-sided)-in 16/130.
The sensory system is the most "rigid" to reorganization probably due to absence of ipsilateral (contralesional) primary somatosensory representation. The motor system is more "flexible" due to ipsilateral (contralesional) motor pathways. The speech perception and production show greater flexibility resulting in more bilateral or contralateral activation.
The models of reorganization are variable, depending on the development and function of each neural system and the extent and timing of the damage. The plasticity patterns may guide therapeutic intervention and prognostics, thus proving the fruitiness of the translational approach in neurosciences.
功能磁共振成像（fMRI）广泛用于研究早期脑损伤后的重组。单侧脑瘫（UCP）是研究大脑可塑性的一个很有吸引力的模型，可通过 fMRI 进行研究。
总结 UCP 任务相关 fMRI 研究的结果，以更好地了解发育中大脑的神经可塑性机制及其重组潜力，并更好地将这方面的知识转化为临床实践。
通过关键词在 PubMed 数据库中进行系统搜索：“脑瘫”、“先天性偏瘫”、“单侧”、“磁共振成像”、“fMRI”、“重组”和“可塑性”。排除标准为：病例报告；综述；非 UCP 患者的研究；以及康复结果的研究。
我们发现有 7 篇文章研究了感觉任务；9 项研究涉及运动任务；12 项研究涉及言语任务。在感觉任务中，优势侧重组占主导地位（77 例患者中有 74 例），仅有 3 例（77 例患者中）发生在非优势侧。在运动任务中，双侧激活在 83 例中有 64 例，仅有非优势侧激活在 83 例中有 11 例，仅有优势侧激活在 83 例中有 8 例。言语感知在 51 例中有 35 例为双侧激活，仅有或优势侧（左侧）在 51 例中有 8 例，仅有或优势侧（右侧）在 51 例中有 8 例。言语产生仅或优势侧（右侧）在 130 例中有 88 例，双侧在 130 例中有 26 例，仅有或优势侧（左侧）在 130 例中有 16 例。
感觉系统由于缺乏同侧（对侧）初级体感代表而最“僵化”，可能需要进行重组。运动系统由于同侧（对侧）运动通路而更“灵活”。言语感知和产生表现出更大的灵活性，从而导致更多的双侧或对侧激活。
重组模型是可变的，取决于每个神经系统的发育和功能以及损伤的程度和时间。这些可塑性模式可能指导治疗干预和预后，从而证明神经科学中转化方法的有效性。
