Rozdíly v modulaci kortikální aktivity u pacientů po cévní mozkové příhodě s reziduální spasticitou ruky léčených botulotoxinem A

English version

Authors: T. Veverka ¹; P. Hlustik ^1,2; P. Hok ¹; Z. Tomasova ¹; P. Otruba ¹; M. Král ¹; Z. Tudos ²; A. Krobot ³; R. Herzig ¹; P. Kaňovský ¹
Authors‘ workplace: Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc Department of Neurology ¹; Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc Department of Radiology ²; Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc Department of Physiotherapy ³
Published in: Cesk Slov Neurol N 2013; 76/109(2): 175-182
Category: Original Paper

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Overview

Cíl:
Cílem naší fMR studie bylo lokalizovat změny aktivace mozkového kortexu u pacientů po cévní mozkové příhodě s reziduální spasticitou ruky léčených botulotoxinem A (BoNT).

Soubor a metodika:
Bylo vyšetřeno 34 pacientů po prodělané cévní mozkové příhodě s reziduální spasticitou ruky; z tohoto počtu vyšetřených byly nezávisle analyzovány dvě homogenní podskupiny. Skupina A byla tvořena 4 mladými pacienty (2 muži, 2 ženy, věk 25 ± 3,4 let, rozptyl 22–31 let) s plegií ruky. Skupina B byla tvořena 5 staršími pacienty (4 muži, 2 ženy, věk 67 ± 11,1 let, rozptyl 54–80) s parézou ruky. Mozkový motorický systém byl mapován pomocí funkční magnetické rezonance (fMR) během provádění motorické úlohy postiženou končetinou (skupina A: myšlený pohybu prstů; skupina B: skutečný pohyb prstů). Vyšetření bylo opakováno dvakrát, vždy před a čtyři týdny po aplikaci BoNT. Skupina B byla vyšetřena ještě potřetí s odstupem 11 týdnů od aplikace BoNT. Změna spasticity byla hodnocena pomocí modifikované Ashworthovy škály (MAS).

Výsledky:
Léčba BoNT snížila spasticitu u všech pacientů; hodnoceno čtyři týdny po aplikaci. fMR před aplikací BoNT ukazovalo abnormně rozsáhlou a bilaterální aktivaci korových oblastí během motorické úlohy. Po aplikaci BoNT došlo k dočasné a částečné normalizaci obrazu aktivace. Kontrast pre- > post-BoNT prokázal signifikantní snížení aktivace v zadním cingulu/precuneu (skupina A) a dorzolaterálním prefrontálním kortexu (skupina B).

Závěr:
Naše výsledky naznačují, že i struktury mimo klasický senzorimotorický systém se uplatňují u postiktální spasticity.

Klíčová slova:
cévní mozková příhoda – spasticita ruky – funkční magnetická rezonance – botulotoxin

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