Kindred John H, Gregory Chris M, Kautz Steven A, Bowden Mark G
Ralph H. Johnson VA Health Care System, Charleston, South Carolina, U.S.A.
Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, U.S.A.; and.
J Clin Neurophysiol. 2024 May 1;41(4):365-372. doi: 10.1097/WNP.0000000000000994. Epub 2023 Mar 8.
Poststroke fatigue (PSF) contributes to increased mortality and reduces participation in rehabilitative therapy. Although PSF's negative influences are well known, there are currently no effective evidence-based treatments for PSF. The lack of treatments is in part because of a dearth of PSF pathophysiological knowledge. Increasing our understanding of PSF's causes may facilitate and aid the development of effective therapies.
Twenty individuals, >6 months post stroke, participated in this cross-sectional study. Fourteen participants had clinically relevant pathological PSF, based on fatigue severity scale (FSS) scores (total score ≥36). Single-pulse and paired-pulse transcranial magnetic stimulation were used to measure hemispheric asymmetries in resting motor threshold, motor evoked potential amplitude, and intracortical facilitation (ICF). Asymmetry scores were calculated as the ratios between lesioned and nonlesioned hemispheres. The asymmetries were then correlated (Spearman rho) to FSS scores.
In individuals with pathological PSF ( N = 14, range of total FSS scores 39-63), a strong positive correlation ( rs = 0.77, P = 0.001) between FSS scores and ICF asymmetries was calculated.
As the ratio of ICF between the lesioned and nonlesioned hemispheres increased so did self-reported fatigue severity in individuals with clinically relevant pathological PSF. This finding may implicate adaptive/maladaptive plasticity of the glutamatergic system/tone as a contributor to PSF. This finding also suggests that future PSF studies should incorporate measuring facilitatory activity and behavior in addition to the more commonly studied inhibitory mechanisms. Further investigations are required to replicate this finding and identify the causes of ICF asymmetries.
中风后疲劳（PSF）会导致死亡率增加，并减少参与康复治疗的机会。尽管PSF的负面影响众所周知，但目前尚无基于证据的有效治疗方法。缺乏治疗方法部分是由于PSF病理生理学知识的匮乏。增进我们对PSF病因的理解可能有助于并推动有效疗法的开发。
20名中风后6个月以上的个体参与了这项横断面研究。根据疲劳严重程度量表（FSS）评分（总分≥36），14名参与者患有临床相关的病理性PSF。使用单脉冲和双脉冲经颅磁刺激来测量静息运动阈值、运动诱发电位幅度和皮质内易化（ICF）的半球不对称性。不对称性得分计算为病变半球与未病变半球之间的比率。然后将这些不对称性与FSS评分进行相关性分析（斯皮尔曼等级相关系数）。
在患有病理性PSF的个体中（N = 14，FSS总分范围为39 - 63），计算出FSS评分与ICF不对称性之间存在强正相关（rs = 0.77，P = 0.001）。
在患有临床相关病理性PSF的个体中，随着病变半球与未病变半球之间ICF比率的增加，自我报告的疲劳严重程度也随之增加。这一发现可能意味着谷氨酸能系统/神经调质的适应性/适应不良可塑性是PSF的一个促成因素。这一发现还表明，未来的PSF研究除了更常研究的抑制机制外，还应纳入对易化活动和行为的测量。需要进一步的研究来重复这一发现并确定ICF不对称性的原因。
