Background

Perinatal stroke often leads to lifelong motor impairment. Two common subtypes differ in timing, location, and mechanism of injury: periventricular venous infarcts (PVI) are fetal white matter lesions while most arterial ischemic strokes (AIS) are cortical injuries acquired near term birth. Both alter motor system development and primary motor cortex (M1) plasticity, often with retained ipsilateral corticospinal fibers from the non-lesioned motor cortex (M1′).

Methods

Task-based functional magnetic resonance imaging was used to define patterns of motor cortex activity during paretic and unaffected hand movement. Peak coordinates of M1, M1′, and the supplementary motor area in the lesioned and intact hemispheres were compared to age-matched controls. Correlations between displacements and clinical motor function were explored.

Results

Forty-nine participants included 14 PVI (12.59 ± 3.7 years), 13 AIS (14.91 ± 3.9 years), and 22 controls (13.91 ± 3.4 years). AIS displayed the greatest M1 displacement from controls in the lesioned hemisphere while PVI locations approximated controls. Peak M1′ activations were displaced from the canonical hand knob in both PVI and AIS. Extent of M1 and M1′ displacement were correlated (r = 0.50, P = 0.025) but were not associated with motor function. Supplementary motor area activity elicited by paretic tapping was displaced in AIS compared to controls (P = 0.003).

Conclusion

Motor network components may be displaced in both hemispheres after perinatal stroke, particularly in AIS and those with ipsilateral control of the affected limb. Modest correlations with clinical function may support that more complex models of developmental plasticity are needed to inform targets for individualized neuromodulatory therapies in children with perinatal stroke.

中文翻译：

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围产期中风偏瘫儿童运动皮层的发育重塑。

背景

围产期卒中通常会导致终生运动障碍。两种常见的亚型在时间、位置和损伤机制上有所不同：脑室周围静脉梗塞 (PVI) 是胎儿白质病变，而大多数动脉缺血性中风 (AIS) 是近期出生后获得的皮质损伤。两者都会改变运动系统发育和初级运动皮层 (M1) 的可塑性，通常保留来自未受损运动皮层 (M1') 的同侧皮质脊髓纤维。

方法

基于任务的功能磁共振成像用于定义麻痹和未受影响的手部运动期间运动皮层活动的模式。将受损和完整半球的 M1、M1' 和辅助运动区域的峰值坐标与年龄匹配的对照进行比较。研究了位移与临床运动功能之间的相关性。

结果

49 名参与者包括 14 名 PVI（12.59 ± 3.7 岁）、13 名 AIS（14.91 ± 3.9 岁）和 22 名对照（13.91 ± 3.4 岁）。AIS 显示在病变半球与对照的最大 M1 位移，而 PVI 位置接近对照。峰值 M1' 激活从 PVI 和 AIS 中的规范手柄移开。M1 和 M1' 位移的程度相关（r = 0.50，P  = 0.025），但与运动功能无关。与对照组相比，由麻痹性敲击引起的补充运动区活动在 AIS 中被取代（P = 0.003）。

结论

围产期卒中后，运动网络组件可能在两个半球发生移位，特别是在 AIS 和患肢同侧控制的患者中。与临床功能的适度相关性可能支持需要更复杂的发育可塑性模型来为围产期卒中儿童的个体化神经调节治疗目标提供信息。