Carr L J
Institute of Child Health, Wolfson Centre, London, UK.
Acta Paediatr Suppl. 1996 Oct;416:53-7. doi: 10.1111/j.1651-2227.1996.tb14278.x.
Reorganization of descending motor pathways was explored in 33 subjects with hemiplegic cerebral palsy. Subjects were assessed neurologically and surface electromyographic recordings were taken from homologous muscles of both hands. Functional corticospinal projections were assessed using focal magnetic stimulation of the motor cortex. In control subjects this evokes EMG responses in the contralateral hand at short latency. Similar results were seen in 12 of the hemiplegic subjects following stimulation of the undamaged motor cortex. In the remaining 22 subjects novel corticospinal pathways were demonstrated arising from the undamaged cortex, where stimulation evoked short latency EMG responses in both hands. Cross-correlation analysis performed from EMGs recorded between the two hands revealed short duration central peaks in 11 of these subjects, all of whom had strong mirror movements of the hands. These findings suggested that two patterns of central reorganization may follow early unilateral cortical insult. Examination further indicated that hand function in hemiplegic subjects could be related to the neurophysiological results.
对33例偏瘫型脑瘫患者的下行运动通路重组情况进行了研究。对患者进行神经学评估，并从双手的同源肌肉记录表面肌电图。使用运动皮层的局灶性磁刺激评估功能性皮质脊髓投射。在对照受试者中，这会在对侧手诱发短潜伏期的肌电图反应。在12例偏瘫患者中，刺激未受损的运动皮层后也观察到了类似结果。在其余22例患者中，发现了源自未受损皮层的新皮质脊髓通路，刺激该通路会在双手诱发短潜伏期的肌电图反应。对双手记录的肌电图进行互相关分析，发现其中11例患者出现了持续时间较短的中央峰值，所有这些患者的双手都有强烈的镜像运动。这些发现表明，早期单侧皮质损伤后可能会出现两种中枢重组模式。进一步检查表明，偏瘫患者的手部功能可能与神经生理学结果有关。
