Dancause Numa, Touvykine Boris, Mansoori Babak K
Département de Neurosciences, Pavillon Paul-G-Desmarais, Université de Montréal, Montréal, QC, Canada; Groupe de Recherche sur le Système Nerveux Central (GRSNC), Faculty of Medicine, SensoriMotor Rehabilitation Research Team of the Canadian Institute of Health Research, Université de Montréal, Montréal, QC, Canada.
Département de Neurosciences, Pavillon Paul-G-Desmarais, Université de Montréal, Montréal, QC, Canada.
Prog Brain Res. 2015;218:361-87. doi: 10.1016/bs.pbr.2015.01.002. Epub 2015 Mar 30.
The last decade of neuroscience research has revealed that the adult brain can undergo substantial reorganization following injury. Plasticity after stroke has traditionally been perceived as adaptive and supporting recovery, but recent studies have suggested that some plasticity may also be detrimental. In particular, increased activity in the unaffected (contralesional) hemisphere has been proposed to contribute to motor deficits of the paretic hand in some patients. Longitudinal imaging studies in humans have reported a progressive behavioral improvement associated with a decrease of contralesional activity and have correlated the intensity of contralesional hemisphere activity with the degree of motor impairment. Consequently, inhibitory neuromodulatory protocols have been applied to the contralesional hemisphere of stroke patients. Such protocols can facilitate the activation of the ipsilesional motor cortex and improve the function of the paretic limb. Although the use of noninvasive techniques after brain injury shows promise, much work needs to be done to understand better how these approaches affect postlesion plasticity and motor recovery. Ultimately, this knowledge will allow for the design of more effective treatments and will potentially lead to protocols adapted to the specific condition of each patient. In this chapter, we review the literature on the basic pathways that can support the effects of contralesional inhibition, interhemispheric interactions, and some of the changes that can occur in the sensorimotor network after stroke. Finally, we show work in rats that demonstrates how parameters of contralesional inactivation can affect postlesion recovery.
过去十年的神经科学研究表明，成人大脑在受伤后能够进行实质性的重组。传统上，中风后的可塑性被认为具有适应性并有助于恢复，但最近的研究表明，某些可塑性也可能有害。特别是，有人提出未受影响（对侧）半球的活动增加会导致一些患者患侧手部的运动功能障碍。对人类的纵向影像学研究报告称，行为的逐步改善与对侧活动的减少有关，并且已将对侧半球活动的强度与运动障碍程度相关联。因此，抑制性神经调节方案已应用于中风患者的对侧半球。此类方案可促进患侧运动皮层的激活并改善患侧肢体的功能。尽管脑损伤后使用非侵入性技术显示出前景，但仍需开展大量工作以更好地了解这些方法如何影响损伤后的可塑性和运动恢复。最终，这些知识将有助于设计更有效的治疗方法，并可能产生适用于每位患者具体情况的方案。在本章中，我们回顾了有关可支持对侧抑制作用的基本通路、半球间相互作用以及中风后感觉运动网络中可能发生的一些变化的文献。最后，我们展示了在大鼠身上进行的研究，该研究证明了对侧失活参数如何影响损伤后的恢复。
