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多发性硬化症中的神经可塑性与运动康复:关于功能和结构变化的MRI标志物的系统综述

Neuroplasticity and Motor Rehabilitation in Multiple Sclerosis: A Systematic Review on MRI Markers of Functional and Structural Changes.

作者信息

Tavazzi Eleonora, Cazzoli Marta, Pirastru Alice, Blasi Valeria, Rovaris Marco, Bergsland Niels, Baglio Francesca

机构信息

IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.

Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.

出版信息

Front Neurosci. 2021 Oct 6;15:707675. doi: 10.3389/fnins.2021.707675. eCollection 2021.

Abstract

Motor rehabilitation is routinely used in clinical practice as an effective method to reduce progressive disability gain in multiple sclerosis (MS), but rehabilitation approaches are typically unstandardized, and only few studies have investigated the impact of rehabilitation on brain neuroplasticity. To summarize and critically analyze studies applying MRI markers of functional connectivity and structural changes to assess the effect of motor rehabilitation on brain neuroplasticity in MS. Literature search was performed using PubMed and EMBASE, selecting studies having as a subject motor rehabilitation and advanced MRI techniques investigating neuroplasticity in adult patients affected by MS. Seventeen out of 798 papers were selected, of which 5 applied structural MRI (4 diffusion tensor imaging, 1 volumetric measurements), 7 applied functional fMRI (5 task-related fMRI, 2 resting-state fMRI) whereas the remaining 5 applied both structural and functional imaging. The considerable data heterogeneity and the small sample sizes characterizing the studies limit interpretation and generalization of the results. Overall, motor rehabilitation promotes clinical improvement, paralleled by positive adaptive brain changes, whose features and extent depend upon different variables, including the type of rehabilitation approach. MRI markers of functional and structural connectivity should be implemented in studies testing the efficacy of motor rehabilitation. They allow for a better understanding of neuroplastic mechanisms underlying rehabilitation-mediated clinical achievements, facilitating the identification of rehabilitation strategies tailored to patients' needs and abilities.

摘要

运动康复在临床实践中经常被用作减少多发性硬化症(MS)患者进行性残疾的有效方法,但康复方法通常不规范,而且只有少数研究调查了康复对脑可塑性的影响。总结并批判性分析应用功能连接和结构变化的MRI标记物来评估运动康复对MS患者脑可塑性影响的研究。使用PubMed和EMBASE进行文献检索,选择以运动康复为主题且采用先进MRI技术研究成年MS患者神经可塑性的研究。从798篇论文中选出17篇,其中5篇应用结构MRI(4篇弥散张量成像,1篇体积测量),7篇应用功能磁共振成像(5篇任务相关功能磁共振成像,2篇静息态功能磁共振成像),其余5篇同时应用结构和功能成像。研究中存在的数据异质性大以及样本量小的特点限制了结果的解释和推广。总体而言,运动康复促进临床改善,同时伴有积极的适应性脑变化,其特征和程度取决于不同变量,包括康复方法的类型。在测试运动康复疗效的研究中应采用功能和结构连接的MRI标记物。它们有助于更好地理解康复介导的临床成果背后的神经可塑性机制,便于确定适合患者需求和能力的康复策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5b6/8526725/f862d8d131b7/fnins-15-707675-g0001.jpg

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