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神经生物学对脑瘫的认识:机制和治疗策略的综述。

Neurobiological Insights Into Cerebral Palsy: A Review of the Mechanisms and Therapeutic Strategies.

机构信息

Department of General Medicine and Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.

出版信息

Brain Behav. 2024 Oct;14(10):e70065. doi: 10.1002/brb3.70065.

Abstract

BACKGROUND

Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by impaired mobility and posture caused by brain injury or abnormal development. CP relates to a variety of neurological mechanisms and pathways that impact the type and severity of motor disability, as well as comorbidities. The heterogeneity in clinical phenotype, pathogenesis, and etiology poses significant challenges for effective therapeutic intervention.

OBJECTIVES

The review aims to provide a comprehensive analysis of the neurobiological mechanisms underlying CP and evaluate current and prospective therapeutic strategies, highlighting the necessity for targeted interventions to address the disorder's multifaceted nature.

METHODS

A thorough literature review was conducted, focusing on studies published in peer-reviewed journals that explore the pathophysiological mechanisms, clinical interventions, and therapeutic strategies for CP.

RESULTS

The pathogenesis of CP involves a complex interplay of genetic, environmental, and perinatal factors leading to brain injury. Inflammatory processes, oxidative stress, and excitotoxicity are critical in CP development. Current therapeutic approaches primarily focus on symptom management through physical and occupational therapy, as well as pharmacological interventions. Emerging therapies, including anti-inflammatory agents, antioxidants, and neuroprotective and neurotrophic agents, show potential but require further validation. Notably, although steroids provide anti-inflammatory benefits, their use in pediatric patients raises concerns regarding long-term adverse effects such as osteoporosis.

CONCLUSION

Despite advances in understanding CP's neurobiological underpinnings, effective therapeutic targets remain elusive. A comprehensive approach addressing CP's heterogeneity is essential. Future research should emphasize in-depth evaluations of the efficacy and safety of therapeutic agents, particularly in pediatric populations, to develop targeted and effective treatments for CP.

摘要

背景

脑瘫(CP)是一种常见的神经发育障碍,其特征为脑损伤或发育异常导致的运动和姿势障碍。CP 与多种神经机制和途径有关,这些机制和途径影响运动残疾的类型和严重程度,以及合并症。临床表型、发病机制和病因的异质性对有效治疗干预提出了重大挑战。

目的

本综述旨在全面分析 CP 的神经生物学机制,并评估当前和潜在的治疗策略,强调针对该疾病多方面性质进行靶向干预的必要性。

方法

进行了全面的文献回顾,重点关注发表在同行评议期刊上的研究,这些研究探讨了 CP 的病理生理学机制、临床干预和治疗策略。

结果

CP 的发病机制涉及遗传、环境和围产期因素的复杂相互作用,导致脑损伤。炎症过程、氧化应激和兴奋性毒性在 CP 的发展中起着关键作用。目前的治疗方法主要集中在通过物理和职业疗法以及药物干预来管理症状。新兴的治疗方法,包括抗炎剂、抗氧化剂以及神经保护和神经营养剂,显示出潜力,但需要进一步验证。值得注意的是,尽管类固醇具有抗炎作用,但在儿科患者中使用类固醇会引起对长期不良反应(如骨质疏松症)的担忧。

结论

尽管在理解 CP 的神经生物学基础方面取得了进展,但仍缺乏有效的治疗靶点。解决 CP 异质性的综合方法至关重要。未来的研究应强调治疗剂的疗效和安全性的深入评估,特别是在儿科人群中,以开发针对 CP 的靶向和有效的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9369/11460637/e2fe79e6eab9/BRB3-14-e70065-g004.jpg

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