Changes in spectroscopic biomarkers after transcranial direct current stimulation in children with perinatal stroke

被引:21
作者
Carlson, Helen L. [1 ,2 ,3 ,4 ]
Ciechanski, Patrick [1 ,2 ]
Harris, Ashley D. [2 ,5 ,8 ,9 ]
MacMaster, Frank P. [2 ,4 ,5 ,6 ,7 ,8 ,10 ]
Kirton, Adam [1 ,2 ,3 ,4 ,5 ]
机构
[1] Alberta Childrens Prov Gen Hosp, Calgary Pediat Stroke Program, Calgary, AB, Canada
[2] ACHRI, Calgary, AB, Canada
[3] Alberta Childrens Prov Gen Hosp, Neurosci, Calgary, AB, Canada
[4] Univ Calgary, Dept Pediat, Calgary, AB, Canada
[5] Univ Calgary, Hotchkiss Brain Inst, Calgary, AB, Canada
[6] Univ Calgary, Dept Psychiat, Calgary, AB, Canada
[7] Univ Calgary, Mathison Ctr Mental Hlth Res & Educ, Calgary, AB, Canada
[8] Alberta Childrens Prov Gen Hosp, CAIR Program, Calgary, AB, Canada
[9] Univ Calgary, Dept Radiol, Calgary, AB, Canada
[10] Alberta Hlth Serv, Strateg Clin Network Addict & Mental Hlth, Calgary, AB, Canada
关键词
Pediatric; MRI; Neuroimaging; MRS; Spectroscopy; Hemiparesis; Cerebral palsy; tDCS; CIMT; Constraint-induced movement therapy; HEMIPLEGIC CEREBRAL-PALSY; NONINVASIVE BRAIN-STIMULATION; MAGNETIC-RESONANCE-SPECTROSCOPY; INDUCED MOVEMENT THERAPY; HUMAN MOTOR CORTEX; ISCHEMIC-STROKE; DEVELOPMENTAL PLASTICITY; CORTICOSPINAL SYSTEM; PEDIATRIC STROKE; EXCITABILITY;
D O I
10.1016/j.brs.2017.09.007
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Perinatal stroke causes lifelong motor disability, affecting independence and quality of life. Non-invasive neuromodulation interventions such as transcranial direct current stimulation (tDCS) combined with intensive therapy may improve motor function in adult stroke hemiparesis but is under-explored in children. Measuring cortical metabolites with proton magnetic resonance spectroscopy (MRS) can inform cortical neurobiology in perinatal stroke but how these change with neuromodulation is yet to be explored. Methods: A double-blind, sham-controlled, randomized clinical trial tested whether tDCS could enhance intensive motor learning therapy in hemiparetic children. Ten days of customized, goal-directed therapy was paired with cathodal tDCS over contralesional primary motor cortex (M1, 20 min, 1.0 mA, 0.04 mA/cm(2)) or sham. Motor outcomes were assessed using validated measures. Neuronal metabolites in both M1s were measured before and after intervention using fMRI-guided short-echo 3T MRS. Results: Fifteen children [age(range) = 12.1(6.6-18.3) years] were studied. Motor performance improved in both groups and tDCS was associated with greater goal achievement. After cathodal tDCS, the non-lesioned M1 showed decreases in glutamate/glutamine and creatine while no metabolite changes occurred with sham tDCS. Lesioned M1 metabolite concentrations did not change post-intervention. Baseline function was highly correlated with lesioned M1 metabolite concentrations (N-acetyl-aspartate, choline, creatine, glutamate/glutamine). These correlations consistently increased in strength following intervention. Metabolite changes were not correlated with motor function change. Baseline lesioned M1 creatine and choline levels were associated with clinical response. Conclusions: MRS metabolite levels and changes may reflect mechanisms of tDCS-related M1 plasticity and response biomarkers in hemiparetic children with perinatal stroke undergoing intensive neurorehabilitation. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:94 / 103
页数:10
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