Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury
ObjectivesIntrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidate...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-05-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.778697/full |
| _version_ | 1828348361626877952 |
|---|---|
| author | Ivana Štětkářová Jiří Keller Jiří Keller |
| author_facet | Ivana Štětkářová Jiří Keller Jiří Keller |
| author_sort | Ivana Štětkářová |
| collection | DOAJ |
| description | ObjectivesIntrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidated. The aim of this study was to evaluate changes in motor cortex activation for healthy upper limbs in comparison to impaired lower limbs by functional magnetic resonance imaging (fMRI).MethodsTen subjects (eight males, 20–69 years) with thoracic SCI presenting no voluntary movements of lower limbs (except one) were enrolled in the fMRI study. fMRI at 1.5T with a finger tapping paradigm and mental movement simulating foot flexion on the dominant side were performed before, 3 months, and 1 year after start of cITBa. fMRI data processing was carried out using FMRI Expert Analysis Tool (FEAT), part of FSL. A second-level analysis was carried out using FLAME stages 1 and 2. The level of spasticity was assessed with the Modified Ashworth scale (MAS).ResultsContinuous ITB significantly decreased limb spasticity in all the subjects (group MAS spasticity dropped from 3 to 0.3). The second-level analysis (Z > 1.6, cluster significance threshold p =0.05) revealed increased activation of the primary sensorimotor cortex of the foot between baseline and 3 months, and 3 months and 1 year.ConclusionIncreased sensorimotor cortex activation with spasticity reduction after cITBa may reflect distant functional reorganization because of long-term mediated neuroplastic changes in the sensorimotor cortex. Better understanding of modulation of brain function in SCI after cITBa may influence the field of neurorehabilitation. |
| first_indexed | 2024-04-14T00:53:50Z |
| format | Article |
| id | doaj.art-b136203d1703450b9763d08aa6ba7abe |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-14T00:53:50Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-b136203d1703450b9763d08aa6ba7abe2022-12-22T02:21:42ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-05-011310.3389/fneur.2022.778697778697Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord InjuryIvana Štětkářová0Jiří Keller1Jiří Keller2Department of Neurology, Third Faculty of Medicine, Královské Vinohrady University Hospital, Prague, CzechiaDepartment of Neurology, Third Faculty of Medicine, Královské Vinohrady University Hospital, Prague, CzechiaDepartment of Radiology, Na Homolce Hospital, Prague, CzechiaObjectivesIntrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidated. The aim of this study was to evaluate changes in motor cortex activation for healthy upper limbs in comparison to impaired lower limbs by functional magnetic resonance imaging (fMRI).MethodsTen subjects (eight males, 20–69 years) with thoracic SCI presenting no voluntary movements of lower limbs (except one) were enrolled in the fMRI study. fMRI at 1.5T with a finger tapping paradigm and mental movement simulating foot flexion on the dominant side were performed before, 3 months, and 1 year after start of cITBa. fMRI data processing was carried out using FMRI Expert Analysis Tool (FEAT), part of FSL. A second-level analysis was carried out using FLAME stages 1 and 2. The level of spasticity was assessed with the Modified Ashworth scale (MAS).ResultsContinuous ITB significantly decreased limb spasticity in all the subjects (group MAS spasticity dropped from 3 to 0.3). The second-level analysis (Z > 1.6, cluster significance threshold p =0.05) revealed increased activation of the primary sensorimotor cortex of the foot between baseline and 3 months, and 3 months and 1 year.ConclusionIncreased sensorimotor cortex activation with spasticity reduction after cITBa may reflect distant functional reorganization because of long-term mediated neuroplastic changes in the sensorimotor cortex. Better understanding of modulation of brain function in SCI after cITBa may influence the field of neurorehabilitation.https://www.frontiersin.org/articles/10.3389/fneur.2022.778697/fullintrathecal baclofenfunctional MRIplasticitymotor cortex activityspinal cord injury |
| spellingShingle | Ivana Štětkářová Jiří Keller Jiří Keller Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury Frontiers in Neurology intrathecal baclofen functional MRI plasticity motor cortex activity spinal cord injury |
| title | Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury |
| title_full | Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury |
| title_fullStr | Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury |
| title_full_unstemmed | Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury |
| title_short | Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury |
| title_sort | modulation of motor cortex activity after intrathecal baclofen delivery in chronic thoracic spinal cord injury |
| topic | intrathecal baclofen functional MRI plasticity motor cortex activity spinal cord injury |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.778697/full |
| work_keys_str_mv | AT ivanastetkarova modulationofmotorcortexactivityafterintrathecalbaclofendeliveryinchronicthoracicspinalcordinjury AT jirikeller modulationofmotorcortexactivityafterintrathecalbaclofendeliveryinchronicthoracicspinalcordinjury AT jirikeller modulationofmotorcortexactivityafterintrathecalbaclofendeliveryinchronicthoracicspinalcordinjury |