Takatsuru Yusuke, Nakamura Kayo, Nabekura Junichi
Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi.
Front Neurol Neurosci. 2013;32:36-44. doi: 10.1159/000346409. Epub 2013 Jul 8.
Many people escape sudden death from ischemic brain stroke, but suffer from severe disabilities such as aphasia and/or paralysis. These survivors of focal brain injury need chronic care to recover from and/or compensate for the impaired sensory and motor functions previously controlled by the focal ischemic core. Functional compensation not only involves the remaining brain areas around the infarction but also the areas contralateral to the stroke lesion, with the need for remodeling of neuronal circuits in some cases. In this review, recent human and animal studies are presented to aid in the understanding of such plasticity in areas contralateral to the stroke lesion providing a new model for rehabilitation. It is well known in the medical field that the intact contralateral hemisphere is recruited for functional remodeling of modalities such as speech. However, the detailed mechanisms underlying these phenomena are less clear. In rodents, in vivo imaging techniques combined with other traditional techniques such as electrophysiology and behavior have revealed that functional recovery is achieved by specific synaptic (neuronal circuit) remodeling of the contralateral area in the 1st week after a focal stroke. The intact contralateral hemisphere can therefore potentially adopt a bilateral function, even in adults, following proper remodeling of neuronal circuits. These recent results suggest a possible new pathway using the intact hemisphere's function to recover lost functions stroke patients.
许多人从缺血性脑中风中逃脱了猝死，但却遭受了诸如失语症和/或瘫痪等严重残疾。这些局灶性脑损伤的幸存者需要长期护理，以从先前由局灶性缺血核心控制的受损感觉和运动功能中恢复和/或进行补偿。功能补偿不仅涉及梗死灶周围剩余的脑区，还涉及中风病灶对侧的区域，在某些情况下还需要重塑神经回路。在这篇综述中，展示了最近的人类和动物研究，以帮助理解中风病灶对侧区域的这种可塑性，为康复提供了一个新模型。在医学领域众所周知，完整的对侧半球会被招募用于诸如言语等功能模式的重塑。然而，这些现象背后的详细机制尚不清楚。在啮齿动物中，体内成像技术与其他传统技术如电生理学和行为学相结合，揭示了在局灶性中风后的第1周，对侧区域通过特定的突触（神经回路）重塑实现功能恢复。因此，即使在成年人中，经过适当的神经回路重塑后，完整的对侧半球也有可能采用双侧功能。这些最新结果表明，利用完整半球的功能来恢复中风患者丧失功能的一种可能的新途径。
