1 Nuffield Department of Clinical Neurosciences, Oxford Centre for FMRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Oxford, UK.
2 Department of Psychiatry, Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Oxford, UK.
J Cereb Blood Flow Metab. 2018 Sep;38(9):1564-1583. doi: 10.1177/0271678X17727670. Epub 2017 Sep 20.
Stroke is a leading cause of long-term disability, with around three-quarters of stroke survivors experiencing motor problems. Intensive physiotherapy is currently the most effective treatment for post-stroke motor deficits, but much recent research has been targeted at increasing the effects of the intervention by pairing it with a wide variety of adjunct therapies, all of which aim to increase cortical plasticity, and thereby hope to maximize functional outcome. Here, we review the literature describing neurochemical changes underlying plasticity induction following stroke. We discuss methods of assessing neurochemicals in humans, and how these measurements change post-stroke. Motor learning in healthy individuals has been suggested as a model for stroke plasticity, and we discuss the support for this model, and what evidence it provides for neurochemical changes. One converging hypothesis from animal, healthy and stroke studies is the importance of the regulation of the inhibitory neurotransmitter GABA for the induction of cortical plasticity. We discuss the evidence supporting this hypothesis, before finally summarizing the literature surrounding the use of adjunct therapies such as non-invasive brain stimulation and SSRIs in post-stroke motor recovery, both of which have been show to influence the GABAergic system.
中风是导致长期残疾的主要原因，大约四分之三的中风幸存者都存在运动问题。目前，强化物理疗法是治疗中风后运动障碍最有效的方法，但最近有很多研究都集中在通过将其与各种辅助疗法相结合来增加干预效果，所有这些方法都旨在增加皮质可塑性，从而最大程度地提高功能恢复。在这里，我们回顾了描述中风后诱导可塑性的神经化学变化的文献。我们讨论了在人类中评估神经化学物质的方法，以及这些测量值在中风后的变化情况。健康个体的运动学习已被提出作为中风可塑性的模型，我们讨论了对该模型的支持以及它为神经化学变化提供的证据。来自动物、健康和中风研究的一个趋同假设是抑制性神经递质 GABA 的调节对于皮质可塑性的诱导很重要。我们讨论了支持这一假设的证据，最后总结了围绕辅助疗法（如非侵入性脑刺激和 SSRIs）在中风后运动恢复中的应用的文献，这些疗法都已显示可以影响 GABA 能系统。
