CNR Neuroscience Institute, Pisa, Italy.
Scuola Normale Superiore, Pisa, Italy.
Elife. 2017 Dec 27;6:e28662. doi: 10.7554/eLife.28662.
Focal cortical stroke often leads to persistent motor deficits, prompting the need for more effective interventions. The efficacy of rehabilitation can be increased by 'plasticity-stimulating' treatments that enhance experience-dependent modifications in spared areas. Transcallosal pathways represent a promising therapeutic target, but their role in post-stroke recovery remains controversial. Here, we demonstrate that the contralesional cortex exerts an enhanced interhemispheric inhibition over the perilesional tissue after focal cortical stroke in mouse forelimb motor cortex. Accordingly, we designed a rehabilitation protocol combining intensive, repeatable exercises on a robotic platform with reversible inactivation of the contralesional cortex. This treatment promoted recovery in general motor tests and in manual dexterity with remarkable restoration of pre-lesion movement patterns, evaluated by kinematic analysis. Recovery was accompanied by a reduction of transcallosal inhibition and 'plasticity brakes' over the perilesional tissue. Our data support the use of combinatorial clinical therapies exploiting robotic devices and modulation of interhemispheric connectivity.
皮质局部脑梗死常导致持续性运动功能障碍，促使我们需要寻找更有效的干预手段。通过“可塑性刺激”治疗来增强对未受影响区域的经验依赖性改变，可以提高康复的效果。胼胝体通路是一个很有前途的治疗靶点，但它们在皮质局部脑梗死后的恢复中的作用仍存在争议。在这里，我们证明在小鼠前肢运动皮质的皮质局部脑梗死中，对侧皮质对病灶周围组织施加了更强的半球间抑制。因此，我们设计了一种康复方案，将机器人平台上的强化、可重复的运动与对侧皮质的可逆失活相结合。这种治疗方法促进了一般运动测试和手动灵巧性的恢复，通过运动学分析评估，显著恢复了损伤前的运动模式。恢复伴随着病灶周围组织的半球间抑制和“可塑性制动器”的减少。我们的数据支持使用组合临床疗法，结合机器人设备和调节半球间连接。
