Accidents vasculaires Cérébraux

Le 16/10/2021 de 09:00 à 11:00

Président(s): Alain Yelnik (Paris);

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Effets des injections de toxine botulique combinées à de la rééducation sur la connectivité fonctionnelle cerveau-muscle, évaluée par une analyse de cohérence cortico-musculaire chez des patients post-AVC.

Célia Delcamp (Toulouse, France), Camille Cormier (Toulouse, France), Alexandre Chalard (Los Angeles, Usa), David Gasq (Toulouse, France), David Amarantini (Toulouse, France)

Objective : Stroke leads to muscle overactivity that can be treated with botulinum toxin injections combined with rehabilitation in routine care. The effects of such treatments on brain-muscle functional connectivity remain to be determined. Cortico-muscular coherence (CMC) between electroencephalography and electromyography is a reference method to study such brain- muscle communication. This study investigates the effects of botulinum toxin combined with rehabilitation on CMC in post-stroke patients.

Material / Patients and Methods : The impact of a treatment combining of botulinum toxin injections in elbow flexors and rehabilitation was assessed in 10 chronic post-stroke patients during 20 active elbow extensions performed at self-selected speed. Difference in elbow range of motion, spastic co-contractions and CMC with the flexor muscles were analyzed with effect size (ES, mean[confidence interval]) between T1 (before injections) and T2/T3 (after 5/19 weeks post-injection, respectively).

Results : Treatment allows a return of CMC toward physiological reference values at T2 (-0.77[-1.47:-0.33]) concomitantly with decreased spastic co-contraction (-0.90[-1.64:-0.52]) and improved active elbow extension range of motion (0.39[0.08:1.37]). Improvement in range of motion and spastic co-contraction was maintained at T3 (0.33[0.04:1.01], and -0.72[-1.42:-0.15], respectively), but not for CMC (-0.06[-0.90:0.64]).

Discussion - Conclusion : In line with the growing interest on CMC for the monitoring of post-stroke patients’ recovering, this study highlights for the first time an effect of treatment combining botulinum toxin and rehabilitation on CMC, allowing a return toward physiological reference values. This work reinforces the interest of CMC for exploring brain-muscles functional connectivity mechanism involved in the plasticity of neuromuscular system of stroke patients.

Keywords : Active range of motion,  Elbow extension, Electroencephalograpy, Electromyography, Neuromuscular plasticity, Spastic co-contraction.