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Funktionelle kortikale Korrelate der Handfunktion

  • Chapter
Handfunktionsstörungen in der Neurologie

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Zusammenfassung

Das motorische System besteht aus einem komplexen Netzwerk kortikaler und subkortikaler Areale, in dem neuronale Populationen durch erregende und hemmende Mechanismen miteinander in Interaktion stehen. Dieses hoch dynamische System wird durch externe und interne Faktoren moduliert, die schließlich die sensorische Wahrnehmung, die Aufmerksamkeit und das motorische Verhalten kontrollieren. Während die Beobachtung solcher Prozesse im Tierexperiment meist mit invasiven Methoden erfolgt (z. B. direkte Ableitung lokaler Feldpotenziale über intrakortikale Elektroden), sind die Möglichkeiten beim Menschen für invasive Messungen neuronaler Aktivität sehr beschränkt. Hier bieten nicht-invasive Bildgebungsverfahren wie

  • die Positronen-Emissions-Tomographie (PET) oder

  • die funktionelle Magnetresonanztomographie (fMRT)

eine wichtige Brücke zur Erforschung struktureller und funktioneller Plastizitätsvorgänge am lebenden menschlichen Gehirn. Eine strukturelle Läsion aufgrund eines Schlaganfalls kann die komplexe Balance erregender und hemmender Einflüsse im motorischen Netzwerk kritisch stören. Eine ischämische Läsion wirkt sich nicht nur direkt auf die absteigenden motorischen Nervenbahnen (d.h. den Tractus corticospinalis) aus, sondern auch auf die funktionelle Netzwerkstruktur entfernter kortikaler Areale beider Hemisphären. Bildgebungsstudien mit fMRT und PET haben übereinstimmend gezeigt, dass Bewegungen der vom Schlaganfall betroffenen Hand verbunden sind mit gesteigerter neuraler Aktivität in der kontraläsionellen, d.h. »gesunden « Hemisphäre, was in alterspassenden Kontrollgruppen nicht zu beobachten ist. Jedoch kann die funktionelle Signifikanz der aktivierten Areale in der nicht betroffenen Hemisphäre zur Bewegung der paretischen Hand – d.h. unterstützend, unspezifisch oder sogar störend – nicht aus klassischen bildgebenden Experimenten gefolgert werden. Das Wissen, wo funktionelle Zustände unterschiedliche Niveaus neuraler Aktivität verursachen, sagt uns nicht, wie eine bestimmte Region mit anderen Regionen in Interaktion steht, die allesamt das Verhalten modulieren. Solche Fragestellungen können besser mit Modellen der funktionellen oder effektiven Konnektivität beantwortet werden, die in den letzten Jahren auch zur Interpretation neuronaler Veränderung bei Schlaganfallpatienten eingesetzt worden sind. Eine solche Systemperspektive auf Hirnnetzwerke ermöglicht neue Einblicke in die Pathophysiologie von Defiziten nach einem Schlaganfall und auf die Einflüsse von therapeutischen Maßnahmen zur Interferenz mit pathologischen Hirnnetzwerken.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln

    Prof. Dr. med. G.R. Fink

  2. Forschungsgruppe »Neuromodulation & Neurorehabilitation« , Max-Planck-Institut für neurologische Forschung, Gleueler Str. 50, 50931, Köln

    PD Dr. med. C. Grefkes

  3. Klinik Kipfenberg Neurologische Fachklinik, Kindinger Str. 13, 85110, Kipfenberg

    PD Dr. med. D.A. Nowak

Authors
  1. Prof. Dr. med. G.R. Fink
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  2. PD Dr. med. C. Grefkes
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  3. PD Dr. med. D.A. Nowak
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© 2011 Springer-Verlag Berlin Heidelberg

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Fink, G., Grefkes, C., Nowak, D. (2011). Funktionelle kortikale Korrelate der Handfunktion. In: Handfunktionsstörungen in der Neurologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-17257-1_13

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  • DOI: https://doi.org/10.1007/978-3-642-17257-1_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-17256-4

  • Online ISBN: 978-3-642-17257-1

  • eBook Packages: Medicine (German Language)

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