经颅磁刺激在围生期脑损伤后婴儿皮质脊髓连接评估中的探索性安全性和可行性：一项观察性研究。
Safety and Feasibility of Transcranial Magnetic Stimulation as an Exploratory Assessment of Corticospinal Connectivity in Infants After Perinatal Brain Injury: An Observational Study.
机构信息
Department of Rehabilitation Medicine, University of Minnesota, MMC 388, 420 Delaware St SE, Minneapolis, MN 55455 (USA). Address all correspondence to Dr Nemanich at:
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong.
出版信息
Phys Ther. 2019 Jun 1;99(6):689-700. doi: 10.1093/ptj/pzz028.
BACKGROUND
Perinatal brain injuries often impact the corticospinal system, leading to motor impairment and cerebral palsy. Although transcranial magnetic stimulation (TMS) has been widely used to study corticospinal connectivity in adults and older children, similar studies of young infants are limited.
OBJECTIVES
The objective was to establish the safety and feasibility of advanced TMS assessments of the corticospinal connectivity of young infants with perinatal brain injury.
DESIGN
This was a pilot, cross-sectional study of 3- to 12-month-old (corrected age) infants with perinatal stroke or intracranial hemorrhage.
METHODS
Six participants (2 term, 4 preterm) were assessed with stereotactic neuronavigation-guided TMS. Single-pulse TMS was applied to each hemisphere and responses were recorded simultaneously from both upper limbs. During data collection, vital signs and stress responses were measured to assess safety. Developmental motor outcomes were evaluated using the General Movements Assessment and Bayley Scales of Infant and Toddler Development (3rd edition). A clinical diagnosis of cerebral palsy was recorded, if available.
RESULTS
No adverse events occurred during TMS testing. All sessions were well tolerated. Contralateral motor evoked responses were detected in 4 of 6 participants. Both contralateral and ipsilateral responses were observed in 2 of 6 participants.
LIMITATIONS
TMS responses were not obtained in all participants. This could be related to the location of brain injury or developmental stage of the corticospinal system controlling the wrist flexor muscle group from which responses were recorded.
CONCLUSIONS
This study provides a summary of the framework for performing novel TMS assessments in infants with perinatal brain injury. Implementing this approach to measure corticospinal connectivity in hypothesis-driven studies in young infants appears to be justified. Such studies could inform the characterization of corticospinal development and the neural mechanisms driving recovery following early interventions.
背景
围产期脑损伤常影响皮质脊髓系统，导致运动障碍和脑瘫。虽然经颅磁刺激（TMS）已广泛用于研究成人和大龄儿童的皮质脊髓连接，但对年轻婴儿的类似研究有限。
目的
本研究旨在确定 TMS 技术在评估围产期脑损伤婴儿皮质脊髓连接中的安全性和可行性。
设计
这是一项针对围产期卒中或颅内出血的 3 至 12 个月（矫正年龄）婴儿的前瞻性、横断面研究。
方法
6 名参与者（2 名足月，4 名早产）接受了立体定向神经导航引导的 TMS 评估。单脉冲 TMS 应用于每侧半球，同时从双侧上肢记录反应。在数据采集过程中，测量生命体征和应激反应以评估安全性。使用 GM 评估和贝利婴幼儿发育量表（第 3 版）评估发育运动结局。如果有条件，记录脑瘫的临床诊断。
结果
TMS 测试过程中未发生不良事件。所有的测试都被很好地耐受。6 名参与者中有 4 名检测到对侧运动诱发电位。6 名参与者中有 2 名观察到对侧和同侧反应。
局限性
并非所有参与者均获得 TMS 反应。这可能与脑损伤的位置或控制记录反应的腕屈肌群组的皮质脊髓系统的发育阶段有关。
结论
本研究提供了在围产期脑损伤婴儿中进行新型 TMS 评估的框架总结。在年轻婴儿中实施这种方法来测量皮质脊髓连接以进行假设驱动的研究似乎是合理的。这些研究可以为皮质脊髓发育的特征描述以及早期干预后神经恢复的神经机制提供信息。
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