Zoghi Maryam, Hafezi Pouya, Amatya Bhasker, Khan Fary, Galea Mary Pauline
Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia.
Monash Health, Melbourne, VIC, Australia.
Front Hum Neurosci. 2020 Aug 24;14:342. doi: 10.3389/fnhum.2020.00342. eCollection 2020.
Spasticity and motor recovery are both related to neural plasticity after stroke. A balance of activity in the primary motor cortex (M1) in both hemispheres is essential for functional recovery. In this study, we assessed the intracortical inhibitory and facilitatory circuits in the contralesional M1 area in four patients with severe upper limb spasticity after chronic stroke and treated with botulinum toxin-A (BoNT-A) injection and 12 weeks of upper limb rehabilitation. There was little to no change in the level of spasticity post-injection, and only one participant experienced a small improvement in arm function. All reported improvements in quality of life. However, the levels of intracortical inhibition and facilitation in the contralesional hemisphere were different at baseline for all four participants, and there was no clear pattern in the response to the intervention. Further investigation is needed to understand how BoNT-A injections affect inhibitory and facilitatory circuits in the contralesional hemisphere, the severity of spasticity, and functional improvement.
痉挛和运动恢复都与中风后的神经可塑性有关。双侧初级运动皮层（M1）活动的平衡对功能恢复至关重要。在本研究中，我们评估了4例慢性中风后患有严重上肢痉挛且接受肉毒杆菌毒素A（BoNT-A）注射和12周上肢康复治疗的患者对侧M1区域的皮质内抑制和易化回路。注射后痉挛程度几乎没有变化，只有一名参与者的手臂功能有小幅改善。所有人都报告生活质量有所提高。然而，所有四名参与者对侧半球的皮质内抑制和易化水平在基线时各不相同，且干预反应没有明显规律。需要进一步研究以了解BoNT-A注射如何影响对侧半球的抑制和易化回路、痉挛的严重程度以及功能改善情况。
