刺激运动前皮质可增强中重度慢性脑卒中患者上肢运动功能恢复的大脑两半球间功能连接。

Stimulation of the Premotor Cortex Enhances Interhemispheric Functional Connectivity in Association with Upper Limb Motor Recovery in Moderate-to-Severe Chronic Stroke.

机构信息

Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

出版信息

Brain Connect. 2023 Oct;13(8):453-463. doi: 10.1089/brain.2022.0064. Epub 2023 Apr 10.

Abstract

Transcranial direct current stimulation (tDCS) targeting the primary motor cortex is modestly effective for promoting upper-limb motor function following stroke. The premotor cortex (PMC) represents an alternative target based on its higher likelihood of survival and dense motor-network connections. The objective of this study was to determine whether ipsilesional PMC tDCS affects motor network functional connectivity (FC) in association with reduction in motor impairment, and to determine whether this relationship is influenced by baseline motor severity. Participants with chronic stroke were randomly assigned to receive active-PMC or sham-tDCS with rehabilitation for 5 weeks. Resting-state functional magnetic resonance imaging was acquired to characterize change in FC across motor-cortical regions. Our results indicated that moderate-to-severe participants who received active-tDCS had greater increases in PMC-to-PMC interhemispheric FC compared to those who received sham; this increase was correlated with reduction in proximal motor impairment. There was also an increase in intrahemispheric dorsal premotor cortex-primary motor cortex FC across participants regardless of severity or tDCS group assignment; this increase was correlated with a reduction in proximal motor impairment in only the mild participants. Our findings have significance for developing targeted brain stimulation approaches. While participants with milder impairments may inherently recruit viable substrates within the ipsilesional hemisphere, stimulation of PMC may enhance interhemispheric FC in association with recovery in more impaired participants. ClinicalTrials.gov Identifier: NCT01539096; Registration date: February 21, 2012.

摘要

经颅直流电刺激(tDCS)靶向初级运动皮层对促进中风后上肢运动功能有一定的效果。基于其更高的存活率和密集的运动网络连接,运动前皮层(PMC)代表了另一个替代目标。本研究的目的是确定同侧 PMC tDCS 是否会影响运动网络功能连接(FC),从而减少运动障碍,并确定这种关系是否受基线运动严重程度的影响。患有慢性中风的参与者被随机分配接受同侧 PMC 或假 tDCS 刺激与康复治疗 5 周。采集静息状态功能磁共振成像以描述跨运动皮质区域的 FC 变化。我们的结果表明,与接受假 tDCS 的参与者相比,接受活跃 tDCS 的中度至重度参与者的 PMC 与 PMC 之间的半球间 FC 增加更大;这种增加与近端运动障碍的减少相关。无论严重程度或 tDCS 分组如何,所有参与者的同侧背侧运动前皮质-初级运动皮质 FC 均增加;这种增加仅与轻度参与者的近端运动障碍减少相关。我们的发现对开发靶向脑刺激方法具有重要意义。虽然轻度损伤的参与者可能固有地在同侧半球内招募可行的基质,但刺激 PMC 可能会增强半球间 FC ,从而促进更严重的参与者的恢复。ClinicalTrials.gov 标识符:NCT01539096;注册日期:2012 年 2 月 21 日。

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