Mano Y, Chuma T, Morimoto S, Takayanagi T
Department of Neurology, Nara Medical University.
Rinsho Shinkeigaku. 1995 Dec;35(12):1515-7.
Plasticity within the human central motor system has been studied with transcranical magnetic stimulation in patients with peripheral and central nervous diseases. In 4 patients with a complete upper limb palsy due to traumatic cervical root avulsion, surgical anastomosis of intercostal to musculocutaneous nerves was performed to restore function in the biceps brachii muscle. The motor unit discharges became independent from respirations gradually over 1 to 2 years. Motor cortex mapping of the reinnervated biceps muscle showed a gradual change over 4 to 33 months from the area of the intercostal muscles to that of the arm area, which was more lateral on the motor cortex. These findings suggest that reorganization of the motor cortex to arm flexor muscles occurs following peripheral nerve anastomosis. In 8 patients with chronic cerebral infarction with hemiplegia. Four of 8 patients did not show MEPs in paralytic hand muscles by contralateral cortex stimulation, but showed small MEPs by ipsilateral cortex stimulation. These cases had the huge cortical infarction unilaterally in CT. Another four of 8 patients showed small MEPs in paralytic hand muscles by contralateral cortex stimulation, but no MEPs by ipsilateral cortex stimulation. These cases had the subcortical infarction unilaterally in CT. These findings suggest that reorganization of motor cortex following unilateral cerebral infarction.
人们已通过经颅磁刺激对患有周围神经和中枢神经疾病的患者的人类中枢运动系统可塑性进行了研究。在4例因外伤性颈神经根撕脱导致上肢完全麻痹的患者中，进行了肋间神经与肌皮神经的手术吻合，以恢复肱二头肌的功能。运动单位放电在1至2年的时间里逐渐与呼吸无关。对重新获得神经支配的肱二头肌进行运动皮层映射显示，在4至33个月的时间里，从肋间肌区域到手臂区域，即运动皮层上更外侧的区域，发生了逐渐变化。这些发现表明，周围神经吻合后，运动皮层会重新组织以支配手臂屈肌。在8例慢性脑梗死偏瘫患者中，8例患者中有4例通过对侧皮层刺激在麻痹的手部肌肉中未显示出运动诱发电位（MEP），但通过同侧皮层刺激显示出较小的MEP。这些病例在CT上表现为单侧巨大皮层梗死。8例患者中的另外4例通过对侧皮层刺激在麻痹的手部肌肉中显示出较小的MEP，但通过同侧皮层刺激未显示出MEP。这些病例在CT上表现为单侧皮质下梗死。这些发现表明单侧脑梗死之后运动皮层会发生重组。
