Berenguer-Rocha Marina, Baltar Adriana, Rocha Sérgio, Shirahige Lívia, Brito Rodrigo, Monte-Silva Kátia
Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Neurol Sci. 2020 Sep;41(9):2591-2598. doi: 10.1007/s10072-020-04350-4. Epub 2020 Apr 7.
To compare the interhemispheric asymmetry of the motor cortex excitability of chronic stroke patients with healthy and to observe if the magnitude of this asymmetry is associated to sensory-motor impairment and stroke chronicity.
This cross-sectional study was performed with chronic stroke and aged and sex-matched healthy individuals. The interhemispheric asymmetry index was calculated by the difference of rest motor threshold (rMT) of the brain hemispheres. The rMT was assessed by transcranial magnetic stimulation over the cortical representation of the first dorsal interosseous muscle. To investigate the relationship of the asymmetry with sensory-motor impairment and injury chronicity, the stroke patients were grouped according to the level of sensory-motor impairment (mild/moderate, moderate/severe, and severe) and different chronicity stages (> 3-12, 13-24, 25-60, and > 60 months since stroke).
Fifty-six chronic stroke and twenty-six healthy were included. We found higher interhemispheric asymmetry in stroke patients (mean, 27.1 ± 20.9) compared to healthy (mean, 4.9 ± 4.7). The asymmetry was higher in patients with moderate/severe (mean, 35.4 ± 20.4) and severe (mean, 32.9 ± 22.7) impairment. No difference was found between patients with mild/moderate impairment (mean, 15.5 ± 12.5) and healthy. There were no differences of the interhemispheric asymmetry between patients with different times since stroke (> 3-12, mean, 32 ± 18.1; > 13-24, mean, 20.7 ± 16.2; > 25-60, mean, 29.6 ± 18.1; > 60 months, mean, 25.9 ± 17.5).
Stroke patients showed higher interhemispheric asymmetry of the motor cortex excitability when compared to healthy, and the magnitude of this asymmetry seems to be correlated with the severity of sensory-motor impairment, but not with stroke chronicity.
Higher interhemispheric asymmetry was found in stroke patients with greatest sensory-motor impairment.
比较慢性卒中患者与健康人运动皮质兴奋性的半球间不对称性，并观察这种不对称性的程度是否与感觉运动障碍及卒中病程相关。
本横断面研究纳入慢性卒中患者以及年龄和性别匹配的健康个体。通过计算大脑半球静息运动阈值（rMT）的差值来得出半球间不对称指数。rMT通过对第一背侧骨间肌的皮质代表区进行经颅磁刺激来评估。为了研究不对称性与感觉运动障碍及损伤病程的关系，将卒中患者按照感觉运动障碍程度（轻度/中度、中度/重度和重度）以及不同病程阶段（卒中后>3 - 12个月、13 - 24个月、25 - 60个月和>60个月）进行分组。
纳入56例慢性卒中患者和26例健康人。我们发现卒中患者的半球间不对称性（均值为27.1±20.9）高于健康人（均值为4.9±4.7）。中度/重度（均值为35.4±20.4）和重度（均值为32.9±22.7）损伤患者的不对称性更高。轻度/中度损伤患者（均值为15.5±12.5）与健康人之间未发现差异。不同卒中时间的患者（>3 - 12个月，均值为32±18.1；>13 - 24个月，均值为20.7±16.2；>25 - 60个月，均值为29.6±18.1；>60个月，均值为25.9±17.5）之间半球间不对称性无差异。
与健康人相比，卒中患者运动皮质兴奋性的半球间不对称性更高，且这种不对称性的程度似乎与感觉运动障碍的严重程度相关，但与卒中病程无关。
在感觉运动障碍最严重的卒中患者中发现了更高的半球间不对称性。
