Gaberova Katerina, Pacheva Iliyana, Sirakov Nikolay, Timova Elena, Ivanov Ivan Stefanov
Department of Pediatrics, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria.
Department of Imaging Diagnostics, Dental Allergology and Physiotherapy, Dental Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria.
Medicina (Kaunas). 2025 Jan 24;61(2):205. doi: 10.3390/medicina61020205.
: Hemiplegic or unilateral cerebral palsy (UCP) is primarily characterized by motor impairment, mainly affecting the upper limb. Research has centered on factors influencing the varying degrees of motor deficit in UCP, using neuroscience advancements for in vivo exploration of brain structure (morphometry) and cortical reorganization (functional magnetic resonance imaging (fMRI)). This study aims to evaluate functional activation in the motor cortex in UCP and to explore how lesion characteristics and timing affect neuroplasticity and motor function. : Between 2017 and 2021, structural and functional MRIs were performed on 44 UCP patients (mean age 15.5 years, 24 males, 20 females), all with Manual Ability Classification System (MACS) levels I-III and Intelligence Quotient (IQ) ≥ 50. The lesion characteristics of size, type, and time of occurrence (ante-, peri-, or early postnatal) were analyzed. An association was sought between the characteristics of the lesion and the degree of motor deficit of the upper limb, as determined by the MACS level. fMRI assessed cortical activation during a finger-tapping task for the paretic hand and compared activation patterns based on lesion characteristics. : Six lesion types were identified, with arterial ischemic stroke being the most common and largest in volume. Lesion size strongly correlated with patients' MACS levels, while lesion type and timing showed no association with the severity of motor impairment classified by MACS. Motor reorganization varied, with activation occurring ipsi-, contra-, or bilaterally to the affected hand, depending on lesion size and type. Smaller, subcortical lesions primarily showed ipsilesional activation, while larger, cortical lesions did not exhibit a specific group activation, possibly due to varying individual reorganization. No association was found between the lesion timing and the reorganization model. : Motor functional reorganization in UCP is closely linked to lesion characteristics, with smaller, subcortical lesions favoring typical organization in the contralateral motor cortex. The timing of the lesion does not significantly affect cortical reorganization. Lesion size was a key determinant of motor function, whereas lesion type (e.g., ischemic stroke) and timing (early vs. late occurrence) were less critical for predicting functional outcome.
偏瘫或单侧脑瘫（UCP）主要特征为运动障碍，主要影响上肢。研究聚焦于影响UCP中不同程度运动缺陷的因素，利用神经科学进展对脑结构（形态测量学）和皮质重组（功能磁共振成像（fMRI））进行体内探索。本研究旨在评估UCP患者运动皮质的功能激活，并探究病变特征和发生时间如何影响神经可塑性和运动功能。
在2017年至2021年期间，对44例UCP患者（平均年龄15.5岁，男24例，女20例）进行了结构和功能磁共振成像检查，所有患者的手动能力分类系统（MACS）等级为I - III级且智商（IQ）≥50。分析了病变的大小、类型和发生时间（产前、围产期或产后早期）等特征。研究寻求病变特征与由MACS等级确定的上肢运动缺陷程度之间的关联。fMRI评估了患侧手在手指敲击任务期间的皮质激活情况，并根据病变特征比较激活模式。
确定了六种病变类型，其中动脉缺血性中风最为常见且体积最大。病变大小与患者的MACS等级密切相关，而病变类型和发生时间与MACS分类的运动障碍严重程度无关。运动重组各不相同，根据病变大小和类型，激活发生在患侧手的同侧、对侧或双侧。较小的皮质下病变主要表现为患侧激活，而较大的皮质病变未表现出特定的组激活模式，这可能是由于个体重组的差异。未发现病变发生时间与重组模式之间存在关联。
UCP中的运动功能重组与病变特征密切相关，较小的皮质下病变有利于对侧运动皮质的典型组织。病变发生时间对皮质重组没有显著影响。病变大小是运动功能的关键决定因素，而病变类型（如缺血性中风）和发生时间（早期与晚期发生）对预测功能结果的重要性较低。
