科研之友
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摘要
Aim: The aim of our functional magnetic resonance (fMRI) study was to localize the changes of cerebral cortex activation in stroke patients suffering from upper limb spasticity and treated with botulinum toxin A (BoNT). Materials and methodology: 34 patients suffering from upper limb post-stroke spasticity were examined; 9 of these patients were grouped into two homogenous subgroups that allowed independent further analysis. Group A consisted of four patients (2 males, 2 females; aged 25.5 +/- 3.4 years, range 22-31 years) who suffered from hand plegia. Group B consisted of five patients (4 males, 1 female; aged 67.0 +/- 11.1 years, range 54-80) who were able to perform real finger movement. The change of arm spasticity was assessed by using the modified Ashworth scale (MAS). fMRI was performed during imaginary movement (group A) or real movement of the impaired hand (group B). fMRI sessions were performed before (WO) and four weeks (W4) after BoNT treatment. Group B underwent additional fMRI 11 weeks (W11) after BoNT application. Results: BoNT treatment decreased arm spasticity in all patients assessed 4 weeks following the BoNT injection. fMRI pre-BoNT treatment showed extensive and bilateral task-related activation of cortical areas. Following the BoNT treatment, temporary and partial shift towards normal distribution of activity occurred. The pre>post-BoNT contrast revealed a significant decrease in activation of the posterior cingulate/precuneus region (group A) and dorsolateral prefrontal cortex (group B). Conclusion: Our results imply that structures outside the traditional sensorimotor system may play a role in the relief of post-stroke spasticity.
- 出版日期2013
