完全性脊髓损伤亚急性期脑运动控制功能变化的功能磁共振研究

doi:10.3969/j.issn.1006-9771.2020.07.004

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 757-765.doi: 10.3969/j.issn.1006-9771.2020.07.004

完全性脊髓损伤亚急性期脑运动控制功能变化的功能磁共振研究

刘舒佳^1,²,张军卫^1,²,王方永^1,²,唐和虎^1,²,白金柱^1,²,吕振^1,²,李建军^1,^3,⁴()

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院脊柱脊髓外科,北京市 100068
3.北京脑重大疾病研究院神经损伤与修复研究所,北京市 100068
4.北京市神经损伤与康复重点实验室,北京市 100068

收稿日期:2020-04-05 修回日期:2020-05-01 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 李建军 E-mail:crrc100@163.com
作者简介:刘舒佳(1979-),男,汉族,山西平定县人,博士,主治医师,主要研究方向：脊柱脊髓损伤的外科治疗与早期康复。|李建军(1962-),男,汉族,教授,主任医师,博士、博士后导师,主要研究方向：骨科及脊柱脊髓损伤的康复与治疗。

Motor Control Function of Brain in Subacute Complete Spinal Cord Injured Patients: A Functional Magnetic Resonance Imaging Study

LIU Shu-jia^1,²,ZHANG Jun-wei^1,²,WANG Fang-yong^1,²,TANG He-hu^1,²,BAI Jin-zhu^1,²,LÜ Zhen^1,²,LI Jian-jun^1,^3,⁴()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing 100068, China
3. Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing 100068, China
4. Beijing Key Laboratoryof Neural Injury and Rehabilitation, Beijing 100068, China

Received:2020-04-05 Revised:2020-05-01 Published:2020-07-25 Online:2020-07-24
Contact: LI Jian-jun E-mail:crrc100@163.com

摘要/Abstract

摘要：

目的探讨完全性脊髓损伤患者脑运动控制功能的变化情况。方法 2017年1月至2019年1月,病程3~6个月完全性脊髓损伤患者11例与健康人12例,在试图/实际运动、意象运动(MI)任务下行功能磁共振成像(fMRI)扫描,观察不同运动任务引发激活效应的空间分布和信号强度。结果患者试图运动时的脑激活区域显著多于健康人实际运动时的激活区域,包括双侧初级感觉/运动皮质(S1/M1)、辅助运动区(SMA)、外侧苍白球(PA)、小脑、左侧丘脑和壳核等。健康人意象运动的比较,患者激活簇主要存在于右M1、SMA、背侧运动前区(PMd)、左SMA、岛叶和基底核。患者试图运动比意象运动在左M1、双SMA、扣带回运动区和右小脑诱发更多的兴奋。结论亚急性期完全性脊髓损伤患者执行运动任务时,M1、SMA的兴奋模式基本正常,顶叶和小脑等感觉运动整合区域激活增加,提示发生适应性重组。

关键词: 脊髓损伤, 脑功能, 运动控制, 功能磁共振成像

Abstract:

Objective To study the changes of brain motor control function in patients with complete spinal cord injury within three to six months. Methods From January, 2017 to January, 2019, eleven inpatients with complete spinal cord injury and twelve healthy controls were screened with functional magnetic resonance imaging during attempted/executive movement (MA/ME) and motor imagery (MI). The involved area and activation were compared between the groups under tasks. Results More areas were activated in the patients than in the controls as MA/ME, such as bilateral primary sensorimotor cortex, supplementary motor area, lateral globus pallidus, cerebellum, contralateral thalamus and putamen. During MI, the activation was more in the patients in ipsilateral primary motor cortex, supplementary motor area, dorsal premotor area, contralateral supplementary motor area, insular and basal ganglia. The patients induced more activation as MA than as MI in ipsilateral primary motor cortex, bilateral supplementary motor area and cingulate motor area, and contralateral cerebellum.Conclusion The activation remains normal in primary motor cortex and supplementary motor area for subacute complete spinal cord injury patients when undergoing motor tasks, but some reorganization may occur in parietal lobe and cerebellum that involve in sensorimotor integration.

Key words: spinal cord injury, brain function, motor control, functional magnetic resonance imaging

中图分类号:

R651.2

刘舒佳,张军卫,王方永,唐和虎,白金柱,吕振,李建军. 完全性脊髓损伤亚急性期脑运动控制功能变化的功能磁共振研究[J]. 《中国康复理论与实践》, 2020, 26(7): 757-765.

LIU Shu-jia,ZHANG Jun-wei,WANG Fang-yong,TANG He-hu,BAI Jin-zhu,LÜ Zhen,LI Jian-jun. Motor Control Function of Brain in Subacute Complete Spinal Cord Injured Patients: A Functional Magnetic Resonance Imaging Study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 757-765.

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参考文献 24

[1]	Lebedev M A, Nicolelis M A. Brain-machine interfaces: from basic science to neuroprostheses and neurorehabilitation[J]. Physiol Rev, 2017, 97(2): 767-837. doi: 10.1152/physrev.00027.2016
[2]	Oni-Orisan A, Kaushal M, Li W, et al. Alterations in cortical sensorimotor connectivity following complete cervical spinal cord injury: a prospective resting-state fMRI study[J]. PLoS One, 2016, 11(3): e0150351. doi: 10.1371/journal.pone.0150351
[3]	Rao J S, Manxiu M, Zhao C, et al. Atrophy and primary somatosensory cortical reorganization after unilateral thoracic spinal cord injury: a longitudinal functional magnetic resonance imaging study[J]. Biomed Res Int, 2013, 2013:753061.
[4]	Kew J J, Ridding M C, Rothwell J C, et al. Reorganization of cortical blood flow and transcranial magnetic stimulation maps in human subjects after upper limb amputation[J]. J Neurophysiol, 1994, 72(5): 2517-2524. pmid: 7884476
[5]	Jutzeler C R, Curt A, Kramer J L. Relationship between chronic pain and brain reorganization after deafferentation: a systematic review of functional MRI findings[J]. Neuroimage Clin, 2015, 9:599-606. doi: 10.1016/j.nicl.2015.09.018
[6]	Zhu L, Wu G, Zhou X, et al. Altered spontaneous brain activity in patients with acute spinal cord injury revealed by resting-state functional MRI[J]. PLoS One, 2015, 10(3): e0118816. doi: 10.1371/journal.pone.0118816
[7]	Rammond D J. Motor imagery: never in your wildest dream[J]. Trend Neurosci, 1997, 20(2): 54-57. doi: 10.1016/S0166-2236(96)30019-2
[8]	Seif M, Curt A, Thompson A J, et al. Quantitative MRI of rostral spinal cord and brain regions is predictive of functional recovery in acute spinal cord injury[J]. Neuroimage Clin, 2018, 20:556-563. doi: 10.1016/j.nicl.2018.08.026
[9]	Vahdat S, Lungu O, Cohen-Adad J, et al. Simultaneous brain-cervical cord fMRI reveals intrinsic spinal cord plasticity during motor sequence learning[J]. PLoS Biol, 2015, 13(6): e1002186. doi: 10.1371/journal.pbio.1002186
[10]	Mohammed H, Hollis E R 2nd. Cortical reorganization of sensorimotor systems and the role of intracortical circuits after spinal cord injury[J]. Neurotherapeutics, 2018, 15(3): 588-603. doi: 10.1007/s13311-018-0638-z pmid: 29882081
[11]	Moxon K A, Oliviero A, Aguilar J, et al. Cortical reorganization after spinal cord injury: always for good?[J]. Neuroscience, 2014, 283:78-94. doi: 10.1016/j.neuroscience.2014.06.056 pmid: 24997269
[12]	Saruco E, Guillot A, Saimpont A, et al. Motor imagery ability of patients with lower-limb amputation: exploring the course of rehabilitation effects[J]. Eur J Phys Rehabil Med, 2019, 55(5): 634-645.
[13]	Smith A C, Weber K A, Parrish T B, et al. Ambulatory function in motor incomplete spinal cord injury: a magnetic resonance imaging study of spinal cord edema and lower extremity muscle morphometry[J]. Spinal Cord, 2017, 55(7): 672-678. doi: 10.1038/sc.2017.18 pmid: 28244504
[14]	Kirshblum S C, Burns S P, Biering-Sorensen F, et al. International Standards for Neurological Classification of Spinal Cord Injury (revised 2011)[J]. J Spinal Cord Med, 2011, 34(6): 535-546. doi: 10.1179/204577211X13207446293695 pmid: 22330108
[15]	Wang Y, Li G, Luk K D K, et al. Component analysis of somatosensory evoked potentials for identifying spinal cord injury location[J]. Sci Rep, 2017, 7(1): 2351. doi: 10.1038/s41598-017-02555-w
[16]	Isaac A, Marks D, Russell E. An instrument for assessing imagery of movement: the Vividness of Movement Imagery Questionnaire (VMIQ)[J]. J Mental Imag, 1986, 10:23-30.
[17]	魏鹏绪, 鲍瑞雪, 张通, 等. 刺激下肢不同穴位在双侧感觉皮质引发的激活效应差异[J]. 中国康复医学杂志, 2010, 25(12): 1144-1147.
	Wei P X, Bao R X, Zhang T, et al. Discrepancy in effects of stimulating different acupoints of unilateral lower extremities on activation responses in bilateral primry somatosensory cortices[J]. Chin J Rehabil Med, 2010, 25(12): 1144-1147.
[18]	Lee B H, Lee K H, Kim U J, et al. Injury in the spinal cord may produce cell death in the brain[J]. Brain Res, 2004, 1020(1-2): 37-44. doi: 10.1016/j.brainres.2004.05.113
[19]	Hawasli A H, Rutlin J, Roland J L, et al. Spinal cord injury disrupts resting-state networks in the human brain[J]. J Neurotrauma, 2018, 35(6): 864-873. doi: 10.1089/neu.2017.5212
[20]	Serradj N, Agger S F, Hollis E R. Corticospinal circuit plasticity in motor rehabilitation from spinal cord injury[J]. Neurosci Lett, 2017, 23(652): 94-104.
[21]	Dias Leao M T, Wiesinger L, Ziemann U, et al. Rapid motor cortical reorganization following subacute spinal cord dysfunction[J]. Brain Stimul, 2020, 13(3): 783-785. doi: S1935-861X(20)30019-X pmid: 32289708
[22]	Sharp K G, Gramer R, Page S J, et al. Increased brain sensorimotor network activation after incomplete spinal cord injury[J]. J Neurotrauma, 2017, 34(3): 623-631. doi: 10.1089/neu.2016.4503
[23]	Liu S J, Wang Y, Wei P X, et al. Brain motor control function in a patient with subacute, incomplete, asymmetrical spinal cord injury[J]. Chin Med J, 2010, 123(13): 1812-1814.
[24]	Porro C A, Francescato M P, Cettolo V, et al. Primary motor and sensory cortex activation during motor performance and motor imagery: a functional magnetic resonance imaging study[J]. J Neurosci, 1996, 16(23): 7688-7698. pmid: 8922425

组别	n	性别 (男/女, n)	年龄(岁)	VMIQ
对照组	12	9/3	32.58±2.42	42.67±2.51
患者组	11	9/2	32.64±2.61	41.00±3.10
t值			0.015	0.419
P值			0.988	0.679

完全性脊髓损伤亚急性期脑运动控制功能变化的功能磁共振研究

Motor Control Function of Brain in Subacute Complete Spinal Cord Injured Patients: A Functional Magnetic Resonance Imaging Study

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