Traversa R, Cicinelli P, Pasqualetti P, Filippi M, Rossini P M
IRCCS Ospedale di Riabilitazione S. Lucia, Neurofisiopatologia, via Ardeatina, 306, 00194, Rome, Italy.
Brain Res. 1998 Aug 24;803(1-2):1-8. doi: 10.1016/s0006-8993(98)00505-8.
We analysed motor-evoked potentials (MEPs) from the hand muscles during focal transcranial magnetic stimulation (TCS) in both the affected (AH) and the unaffected (UH) hemispheres of 17 monohemispheric stroke patients followed-up in subacute stage. Recording sessions were performed at 2 (T1 session) and 4 (T2 session) months from acute stroke. Clinical and functional scores were evaluated. An age-sex matched group of 20 healthy subjects have been referenced. In T1, relaxed MEPs from AH were smaller than UH (p<0.001) and normals (p<0.001). In T2, an increase of AH relaxed-MEPs amplitude was observed, combined with an improvement of clinical and functional scores (p<0.001). On the other hand, the amplitude of contracted MEPs from the AH in T1 was larger than in the normal group. This parameter decreased toward normal limits in T2, provided that the amplitude of the MEPs from the AH improved, while it further increased when TCS of the AH continued to fail in eliciting MEPs. This phenomenon was statistically combined with clinical improvement of disability and neurological scores. Recovery of the excitability AH threshold with progressive 'balancing' of the UH hyperresponsiveness represents a good prognostic parameter for clinical outcome of hand motor function.
我们分析了17例单侧半球卒中患者亚急性期随访时，在患侧半球（AH）和健侧半球（UH）进行局灶性经颅磁刺激（TCS）期间手部肌肉的运动诱发电位（MEP）。在急性卒中后2个月（T1期）和4个月（T2期）进行记录。评估临床和功能评分，并参考了20名年龄和性别匹配的健康受试者组成的对照组。在T1期，AH的静息MEP小于UH（p<0.001）和正常组（p<0.001）。在T2期，观察到AH静息MEP振幅增加，同时临床和功能评分改善（p<0.001）。另一方面，T1期AH的收缩MEP振幅大于正常组。该参数在T2期向正常范围降低，前提是AH的MEP振幅改善，而当AH的TCS继续无法引出MEP时，该参数进一步增加。这种现象在统计学上与残疾和神经学评分的临床改善相关。随着UH高反应性逐渐“平衡”，AH兴奋性阈值的恢复是手部运动功能临床预后的良好预测指标。
