Meinzer Marcus, Flaisch Tobias, Breitenstein Caterina, Wienbruch Christian, Elbert Thomas, Rockstroh Brigitte
Department of Clinical Psychology and Neuropsychology, University of Konstanz, Universitätsstrasse 10, Konstanz, Germany.
Neuroimage. 2008 Feb 15;39(4):2038-46. doi: 10.1016/j.neuroimage.2007.10.008. Epub 2007 Oct 18.
Functional recovery in response to a brain lesion, such as a stroke, can even occur years after the incident and may be accelerated by effective rehabilitation strategies. In eleven chronic aphasia patients, we administered a short-term intensive language training to improve language functions and to induce cortical reorganization under rigorously controlled conditions. Overt naming performance was assessed during functional magnetic resonance imaging (fMRI) prior to and immediately after the language training. Regions of interest (ROIs) for statistical analyses were constituted by areas with individually determined abnormally high densities of slow wave generators (identified by magnetoencephalography prior to the language intervention) that clustered mainly in left perilesional areas. Three additional individually defined regions served to control for the specificity of the results for the selected respective target region: the homologue area of the individual patient's lesion, the mirror image of the delta ROI in the right hemisphere and left hemispheric regions that did not produce a significant amount of slow wave activity. Treatment-induced changes of fMRI brain activation were highly correlated with improved naming of the trained pictures, but selectively within the pre-training dysfunctional perilesional brain areas. Our results suggest that remodeling of cortical functions is possible even years after a stroke. The behavioral gain seems to be mediated by brain regions that had been partially deprived from input after the initial stroke. We therefore provide first time direct evidence for the importance of treatment-induced functional reintegration of perilesional areas in a heterogeneous sample of chronic aphasia patients.
对脑部损伤（如中风）的功能恢复甚至可能在事件发生数年之后出现，有效的康复策略可能会加速这种恢复。在11名慢性失语症患者中，我们进行了短期强化语言训练，以改善语言功能并在严格控制的条件下诱导皮质重组。在语言训练之前和之后立即进行功能磁共振成像（fMRI）时评估明显的命名表现。用于统计分析的感兴趣区域（ROI）由具有个体确定的异常高密度慢波发生器的区域构成（在语言干预之前通过脑磁图识别），这些区域主要聚集在左侧病变周围区域。另外三个单独定义的区域用于控制所选各个目标区域结果的特异性：个体患者病变的同源区域、右半球中δROI的镜像以及未产生大量慢波活动的左半球区域。治疗引起的fMRI脑激活变化与训练图片命名的改善高度相关，但仅在训练前功能失调的病变周围脑区内具有选择性。我们的结果表明，即使在中风数年之后，皮质功能重塑也是可能的。行为改善似乎是由最初中风后部分失去输入的脑区介导的。因此，我们首次为在慢性失语症患者的异质样本中治疗诱导的病变周围区域功能重新整合的重要性提供了直接证据。
