Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.
Department of Neurology, VAMED Hospital Kipfenberg, Konrad-Regler-Straße 1, 85110, Kipfenberg, Germany.
J Neuroeng Rehabil. 2021 Nov 3;18(1):158. doi: 10.1186/s12984-021-00947-8.
Resting motor threshold is an objective measure of cortical excitability. Numerous studies indicate that the success of motor recovery after stroke is significantly determined by the direction and extent of cortical excitability changes. A better understanding of this topic (particularly with regard to the level of motor impairment and the contribution of either cortical hemisphere) may contribute to the development of effective therapeutical strategies in this cohort.
This systematic review collects and analyses the available evidence on resting motor threshold and hand motor recovery in stroke patients.
PubMed was searched from its inception through to 31/10/2020 on studies investigating resting motor threshold of the affected and/or the non-affected hemisphere and motor function of the affected hand in stroke cohorts.
Overall, 92 appropriate studies (including 1978 stroke patients and 377 healthy controls) were identified. The analysis of the data indicates that severe hand impairment is associated with suppressed cortical excitability within both hemispheres and with great between-hemispheric imbalance of cortical excitability. Favorable motor recovery is associated with an increase of ipsilesional motor cortex excitability and reduction of between-hemispheric imbalance. The direction of change of contralesional motor cortex excitability depends on the amount of hand motor impairment. Severely disabled patients show an increase of contralesional motor cortex excitability during motor recovery. In contrast, recovery of moderate to mild hand motor impairment is associated with a decrease of contralesional motor cortex excitability.
This data encourages a differential use of rehabilitation strategies to modulate cortical excitability. Facilitation of the ipsilesional hemisphere may support recovery in general, whereas facilitation and inhibition of the contralesional hemisphere may enhance recovery in severe and less severely impaired patients, respectively.
静息运动阈值是皮质兴奋性的客观测量指标。大量研究表明，中风后运动功能恢复的成功与否，在很大程度上取决于皮质兴奋性变化的方向和程度。更好地了解这一主题（特别是在运动损伤程度和两个皮质半球的贡献方面）可能有助于为这一人群制定有效的治疗策略。
本系统综述收集并分析了关于中风患者静息运动阈值和手部运动恢复的现有证据。
从 1966 年 1 月 1 日至 2020 年 10 月 31 日，通过 PubMed 检索了关于研究受影响和/或未受影响半球的静息运动阈值以及中风队列中受影响手运动功能的研究。
共确定了 92 项合适的研究（包括 1978 例中风患者和 377 例健康对照者）。数据分析表明，严重的手部功能障碍与双侧半球皮质兴奋性抑制以及皮质兴奋性的巨大半球间失衡有关。有利的运动恢复与对侧运动皮质兴奋性的增加和半球间失衡的减少有关。对侧运动皮质兴奋性变化的方向取决于手部运动损伤的程度。严重残疾患者在运动恢复过程中表现出对侧运动皮质兴奋性的增加。相比之下，中度至轻度手部运动功能障碍的恢复与对侧运动皮质兴奋性的降低有关。
这些数据鼓励采用不同的康复策略来调节皮质兴奋性。促进优势半球的功能可能有助于总体恢复，而促进和抑制对侧半球可能分别有助于严重和轻度受损患者的恢复。
