Štětkářová Ivana, Keller Jiří
Department of Neurology, Third Faculty of Medicine, Královské Vinohrady University Hospital, Prague, Czechia.
Department of Radiology, Na Homolce Hospital, Prague, Czechia.
Front Neurol. 2022 May 13;13:778697. doi: 10.3389/fneur.2022.778697. eCollection 2022.
Intrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidated. The aim of this study was to evaluate changes in motor cortex activation for healthy upper limbs in comparison to impaired lower limbs by functional magnetic resonance imaging (fMRI).
Ten subjects (eight males, 20-69 years) with thoracic SCI presenting no voluntary movements of lower limbs (except one) were enrolled in the fMRI study. fMRI at 1.5T with a finger tapping paradigm and mental movement simulating foot flexion on the dominant side were performed before, 3 months, and 1 year after start of cITBa. fMRI data processing was carried out using FMRI Expert Analysis Tool (FEAT), part of FSL. A second-level analysis was carried out using FLAME stages 1 and 2. The level of spasticity was assessed with the Modified Ashworth scale (MAS).
Continuous ITB significantly decreased limb spasticity in all the subjects (group MAS spasticity dropped from 3 to 0.3). The second-level analysis (Z > 1.6, cluster significance threshold =0.05) revealed increased activation of the primary sensorimotor cortex of the foot between baseline and 3 months, and 3 months and 1 year.
Increased sensorimotor cortex activation with spasticity reduction after cITBa may reflect distant functional reorganization because of long-term mediated neuroplastic changes in the sensorimotor cortex. Better understanding of modulation of brain function in SCI after cITBa may influence the field of neurorehabilitation.
鞘内注射巴氯芬（ITB）常用于减轻慢性脊髓损伤（SCI）患者的痉挛。其临床效果众所周知；然而，持续鞘内注射巴氯芬（cITBa）对皮质过程调节的长期作用的确切机制尚未阐明。本研究的目的是通过功能磁共振成像（fMRI）评估健康上肢与受损下肢相比运动皮质激活的变化。
10名胸段SCI患者（8名男性，年龄20 - 69岁），下肢无自主运动（1名除外），纳入fMRI研究。在开始cITBa之前、3个月和1年后，采用1.5T fMRI，以手指敲击范式和模拟优势侧足部屈曲的心理运动进行检查。使用FSL的一部分FMRI专家分析工具（FEAT）进行fMRI数据处理。使用FLAME第1阶段和第2阶段进行二级分析。采用改良Ashworth量表（MAS）评估痉挛程度。
持续ITB显著降低了所有受试者的肢体痉挛（组MAS痉挛程度从3降至0.3）。二级分析（Z > 1.6，聚类显著性阈值 = 0.05）显示，在基线与3个月之间以及3个月与1年之间，足部初级感觉运动皮质的激活增加。
cITBa后随着痉挛减轻感觉运动皮质激活增加，可能反映了由于感觉运动皮质长期介导的神经可塑性变化导致的远距离功能重组。更好地理解cITBa后SCI患者脑功能的调节可能会影响神经康复领域。
