Shanks Maxine J, Byblow Winston D
Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.
Centre for Brain Research, University of Auckland, Auckland, New Zealand.
J Physiol. 2025 Feb;603(3):651-662. doi: 10.1113/JP285562. Epub 2024 May 30.
Stroke is a leading cause of adult disability that results in motor deficits and reduced independence. Regaining independence relies on motor recovery, particularly regaining function of the hand and arm. This review presents evidence from human studies that have used transcranial magnetic stimulation (TMS) to identify neurophysiological mechanisms underlying upper limb motor recovery early after stroke. TMS studies undertaken at the subacute stage after stroke have identified several neurophysiological factors that can drive motor impairment, including membrane excitability, the recruitment of corticomotor neurons, and glutamatergic and GABAergic neurotransmission. However, the inherent variability and subsequent poor reliability of measures derived from motor evoked potentials (MEPs) limit the use of TMS for prognosis at the individual patient level. Currently, prediction tools that provide the most accurate information about upper limb motor outcomes for individual patients early after stroke combine clinical measures with a simple neurophysiological biomarker based on MEP presence or absence, i.e. MEP status. Here, we propose a new compositional framework to examine MEPs across several upper limb muscles within a threshold matrix. The matrix can provide a more comprehensive view of corticomotor function and recovery after stroke by quantifying the evolution of subthreshold and suprathreshold MEPs through compositional analyses. Our contention is that subthreshold responses might be the most sensitive to reduced output of corticomotor neurons, desynchronized firing of the remaining neurons, and myelination processes that occur early after stroke. Quantifying subthreshold responses might provide new insights into post-stroke neurophysiology and improve the accuracy of prediction of upper limb motor outcomes.
中风是导致成人残疾的主要原因,会造成运动功能障碍并降低独立性。恢复独立性依赖于运动功能的恢复,尤其是手部和手臂功能的恢复。本综述展示了来自人体研究的证据,这些研究使用经颅磁刺激(TMS)来确定中风后早期上肢运动恢复背后的神经生理机制。在中风后的亚急性期进行的TMS研究已经确定了几个可导致运动功能障碍的神经生理因素,包括膜兴奋性、皮质运动神经元的募集以及谷氨酸能和γ-氨基丁酸能神经传递。然而,运动诱发电位(MEP)测量结果固有的变异性以及随之而来的低可靠性限制了TMS在个体患者预后评估中的应用。目前,能够在中风后早期为个体患者提供最准确的上肢运动结果信息的预测工具,是将临床测量与基于MEP是否存在的简单神经生理生物标志物(即MEP状态)相结合。在此,我们提出了一个新的构成框架,用于在阈值矩阵内检查多个上肢肌肉的MEP。通过成分分析量化阈下和阈上MEP的演变,该矩阵可以提供中风后皮质运动功能和恢复的更全面视图。我们的观点是,阈下反应可能对中风后早期发生的皮质运动神经元输出减少、剩余神经元的不同步放电以及髓鞘形成过程最为敏感。量化阈下反应可能会为中风后神经生理学提供新的见解,并提高上肢运动结果预测的准确性。