Dijkhuizen Rick M, Zaharchuk Greg, Otte Willem M
aBiomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands bDepartment of Radiology, Stanford University School of Medicine, Stanford, California, USA cDepartment of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Curr Opin Neurol. 2014 Dec;27(6):637-43. doi: 10.1097/WCO.0000000000000150.
Stroke is a major cause of disability; however, most patients experience spontaneous partial recovery of functions in subacute to chronic phases. Poststroke loss and recovery of functions have been increasingly correlated with brain-wide alterations in the connectivity of neural networks, which is described in this review. Elucidation of the mechanisms of functional brain remodeling could reveal targets and strategies for more effective neurorehabilitation.
Data from recent resting-state functional MRI, electroencephalography, magnetoencephalography, and optical imaging studies in patients and animal models have demonstrated that loss of function after stroke is closely associated with disrupted connectivity in large-scale networks beyond the lesion territory. Restoration of functional connectivity in the surviving networks appears to be critical for functional recovery, and this may be promoted with specific therapeutic strategies, such as robot-assisted training and noninvasive brain stimulation. The adaptability of functional networks relies on the structural integrity of neuronal pathways, but the relationship between the two remains incompletely understood. Furthermore, disturbed neurovascular coupling after stroke can confound hemodynamically based measurements of functional connectivity.
Identification of key network processes in adaptive brain plasticity can aid in the prediction of functional outcome and the development of therapeutic interventions to support and promote recovery after stroke.
中风是导致残疾的主要原因；然而，大多数患者在亚急性期至慢性期会出现功能的自发部分恢复。中风后功能的丧失和恢复越来越多地与神经网络连接的全脑改变相关，本综述对此进行了描述。阐明功能性脑重塑的机制可能会揭示更有效的神经康复的靶点和策略。
近期针对患者和动物模型的静息态功能磁共振成像、脑电图、脑磁图和光学成像研究的数据表明，中风后功能丧失与病变区域以外的大规模网络连接中断密切相关。存活网络中功能连接的恢复似乎对功能恢复至关重要，并且这可以通过特定的治疗策略来促进，如机器人辅助训练和非侵入性脑刺激。功能网络的适应性依赖于神经通路的结构完整性，但两者之间的关系仍未完全理解。此外，中风后神经血管耦合紊乱会混淆基于血流动力学的功能连接测量。
识别适应性脑可塑性中的关键网络过程有助于预测功能结果，并有助于开发支持和促进中风后恢复的治疗干预措施。
