1 Department of Clinical Neurosciences, University Hospital, Geneva, Switzerland2 Department of Psychiatry, Madison, Wisconsin, USA
2 Department of Psychiatry, Madison, Wisconsin, USA.
Brain. 2014 Sep;137(Pt 9):2408-22. doi: 10.1093/brain/awu101. Epub 2014 May 28.
After a century of false hopes, recent studies have placed the concept of diaschisis at the centre of the understanding of brain function. Originally, the term 'diaschisis' was coined by von Monakow in 1914 to describe the neurophysiological changes that occur distant to a focal brain lesion. In the following decades, this concept triggered widespread clinical interest in an attempt to describe symptoms and signs that the lesion could not fully explain. However, the first imaging studies, in the late 1970s, only partially confirmed the clinical significance of diaschisis. Focal cortical areas of diaschisis (i.e. focal diaschisis) contributed to the clinical deficits after subcortical but only rarely after cortical lesions. For this reason, the concept of diaschisis progressively disappeared from the mainstream of research in clinical neurosciences. Recent evidence has unexpectedly revitalized the notion. The development of new imaging techniques allows a better understanding of the complexity of brain organization. It is now possible to reliably investigate a new type of diaschisis defined as the changes of structural and functional connectivity between brain areas distant to the lesion (i.e. connectional diaschisis). As opposed to focal diaschisis, connectional diaschisis, focusing on determined networks, seems to relate more consistently to the clinical findings. This is particularly true after stroke in the motor and attentional networks. Furthermore, normalization of remote connectivity changes in these networks relates to a better recovery. In the future, to investigate the clinical role of diaschisis, a systematic approach has to be considered. First, emerging imaging and electrophysiological techniques should be used to precisely map and selectively model brain lesions in human and animals studies. Second, the concept of diaschisis must be applied to determine the impact of a focal lesion on new representations of the complexity of brain organization. As an example, the evaluation of remote changes in the structure of the connectome has so far mainly been tested by modelization of focal brain lesions. These changes could now be assessed in patients suffering from focal brain lesions (i.e. connectomal diaschisis). Finally, and of major significance, focal and non-focal neurophysiological changes distant to the lesion should be the target of therapeutic strategies. Neuromodulation using transcranial magnetic stimulation is one of the most promising techniques. It is when this last step will be successful that the concept of diaschisis will gain all the clinical respectability that could not be obtained in decades of research.
一个世纪以来的种种泡影之后,最近的研究将失联络现象的概念置于对大脑功能理解的中心位置。起初,术语“失联络现象”是由 von Monakow 于 1914 年创造的,用于描述发生在局灶性脑损伤远处的神经生理学变化。在接下来的几十年里,这个概念引发了广泛的临床兴趣,试图描述病灶无法完全解释的症状和体征。然而,在 20 世纪 70 年代后期的第一批影像学研究仅部分证实了失联络现象的临床意义。局灶性皮质区失联络(即局灶性失联络)导致皮质下病变后但很少导致皮质病变后的临床缺陷。因此,失联络现象的概念逐渐从临床神经科学的主流研究中消失。最近的证据出人意料地重新激活了这一概念。新成像技术的发展使人们能够更好地理解大脑组织的复杂性。现在可以可靠地研究一种新的失联络现象,定义为病灶远处脑区之间结构和功能连接的变化(即连接性失联络现象)。与局灶性失联络现象相反,关注特定网络的连接性失联络现象似乎与临床发现更一致。这在运动和注意力网络中风后的情况尤其如此。此外,这些网络中远程连接变化的正常化与更好的恢复相关。在未来,为了研究失联络现象的临床作用,必须考虑一种系统的方法。首先,新兴的影像学和电生理学技术应该用于在人类和动物研究中精确地绘制和选择性地模拟脑损伤。其次,必须应用失联络现象的概念来确定局灶性病变对大脑组织复杂性新表现的影响。例如,对连接组结构的远程变化的评估迄今为止主要通过局灶性脑损伤的模型化来测试。这些变化现在可以在患有局灶性脑损伤的患者中进行评估(即连接组失联络现象)。最后,也是最重要的,病灶远处的局灶性和非局灶性神经生理变化应该成为治疗策略的目标。经颅磁刺激的神经调节是最有前途的技术之一。当这最后一步成功时,失联络现象的概念将获得几十年研究都无法获得的所有临床可信度。
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