中风中的脑兴奋性:中风进展的阴阳学说
Brain excitability in stroke: the yin and yang of stroke progression.
作者信息
Carmichael S Thomas
机构信息
Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
出版信息
Arch Neurol. 2012 Feb;69(2):161-7. doi: 10.1001/archneurol.2011.1175. Epub 2011 Oct 10.
There is no current medical therapy for stroke recovery. Principles of physiological plasticity have been identified during recovery in both animal models and human stroke. Stroke produces a loss of physiological brain maps in adjacent peri-infarct cortex and then a remapping of motor and sensory functions in this region. This remapping of function in peri-infarct cortex correlates closely with recovery. Recent studies have shown that the stroke produces abnormal conditions of excitability in neuronal circuits adjacent to the infarct that may be the substrate for this process of brain remapping and recovery. Stroke causes a hypoexcitability in peri-infarct motor cortex that stems from increased tonic γ-aminobutyric acid activity onto neurons. Drugs that reverse this γ-aminobutyric acid signaling promote recovery after stroke. Stroke also increases the sensitivity of glutamate receptor signaling in peri-infarct cortex well after the stroke event, and stimulating α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate glutamate receptors in peri-infarct cortex promotes recovery after stroke. Both blocking tonic γ-aminobutyric acid currents and stimulating α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors promote recovery after stroke when initiated at quite a delay, more than 3 to 5 days after the infarct. These changes in the excitability of neuronal circuits in peri-infarct cortex after stroke may underlie the process of remapping motor and sensory function after stroke and may identify new therapeutic targets to promote stroke recovery.
目前尚无针对中风恢复的医学疗法。在动物模型和人类中风恢复过程中,已经确定了生理可塑性的原理。中风会导致梗死灶周围相邻皮质区域的生理脑图谱丧失,随后该区域的运动和感觉功能会重新映射。梗死灶周围皮质区域功能的这种重新映射与恢复密切相关。最近的研究表明,中风会在梗死灶附近的神经回路中产生异常的兴奋性状态,这可能是大脑重新映射和恢复过程的基础。中风会导致梗死灶周围运动皮质兴奋性降低,这源于神经元上持续性γ-氨基丁酸活性增加。逆转这种γ-氨基丁酸信号传导的药物可促进中风后的恢复。中风还会在中风事件发生很久之后增加梗死灶周围皮质中谷氨酸受体信号的敏感性,刺激梗死灶周围皮质中的α-氨基-3-羟基-5-甲基-4-异恶唑丙酸谷氨酸受体可促进中风后的恢复。当在梗死发生3至5天以上的相当长时间后开始进行时,阻断持续性γ-氨基丁酸电流和刺激α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体均可促进中风后的恢复。中风后梗死灶周围皮质神经回路兴奋性的这些变化可能是中风后运动和感觉功能重新映射过程的基础,并可能确定促进中风恢复的新治疗靶点。
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