Hamzei Farsin, Erath Gabriele, Kücking Ursula, Weiller Cornelius, Rijntjes Michel
Section of Neurological Rehabilitation, Hans Berger Clinic of Neurology, Department of Neurology, Jena University Hospital, Jena, Germany.
Department of Neurology, Moritz Klinik, Bad Klosterlausnitz, Germany.
Eur J Neurosci. 2020 Sep;52(6):3628-3641. doi: 10.1111/ejn.14698. Epub 2020 Feb 25.
To improve clinical outcome, one longstanding goal in treating stroke patients has been an individual therapy based on functional and anatomical knowledge of the single patient. Therefore, in this study brain imaging of 36 chronic stroke patients was analyzed to identify parameters predicting clinical recovery. T1-weighted MRI was acquired to assess the lesion; functional MRI was used to visualize existing resources; DTI for the integrity of the corticospinal tract (CST) and long association tracts. These data were related to the clinical course. All patients were treated intensively with the mirror therapy (MT) only. After the training period, we analyzed which patient's feature would predict a beneficial course. Patients as a group improved after MT, but according to the fMRI activation of primary sensorimotor cortex (SMC), they could be divided in two groups with very diverging clinical outcome: those with ipsilesional SMC activation showed a noticeable increase of clinical scores, accompanied with ipsilesional activation in the frontal projection areas of the dorsal and ventral streams during action observation in fMRI. Those with contralesional SMC activation had lesions affecting both the dorsal and ventral stream and did not benefit from MT. The outcome for this therapy was not related to affection of CST. This study demonstrates that only in patients in which dorsal and ventral streams are not affected and therefore an interaction between these streams in post- and prerolandic regions is possible, MT can induce clinical improvement. Consequently, knowledge of the anatomical lesion can predict the beneficial course of MT.
为改善临床预后，治疗中风患者的一个长期目标是基于单个患者的功能和解剖学知识进行个体化治疗。因此，在本研究中，对36例慢性中风患者的脑成像进行了分析，以确定预测临床恢复的参数。采集T1加权MRI以评估病变；功能MRI用于可视化现有资源；弥散张量成像（DTI）用于评估皮质脊髓束（CST）和长联合纤维束的完整性。这些数据与临床病程相关。所有患者仅接受了强化镜像疗法（MT）治疗。训练期结束后，我们分析了哪些患者特征可预测良好的病程。作为一个整体，患者在接受MT治疗后有所改善，但根据初级感觉运动皮层（SMC）的功能磁共振成像激活情况，他们可分为两组，临床预后差异很大：患侧SMC激活的患者临床评分显著提高，在功能磁共振成像动作观察期间，背侧和腹侧流的额叶投射区出现患侧激活。对侧SMC激活的患者病变累及背侧和腹侧流，未从MT中获益。该疗法的结果与CST是否受累无关。本研究表明，只有在背侧和腹侧流未受影响、因此在中央后回和中央前回区域这些流之间可能存在相互作用的患者中，MT才能诱导临床改善。因此，解剖学病变的知识可以预测MT的良好病程。
