Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy.
Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy.
Mult Scler. 2019 Sep;25(10):1348-1362. doi: 10.1177/1352458519846096.
Neural plasticity represents the substrate by which the damaged central nervous system (CNS) re-learns lost behaviors in response to rehabilitation. In persons with multiple sclerosis (MS), rehabilitation can therefore exploit the potential of neural plasticity to restore CNS functions beyond the spontaneous mechanisms of recovery from MS-related damage.
Here, we reviewed the currently available evidence on the occurrence of mechanisms of structural and functional plasticity following rehabilitation, motor, and/or cognitive training. We presented both data gained from basic laboratory research on animal models and data on persons with MS obtained by advanced magnetic resonance imaging (MRI) techniques.
Studies on physical and environmental enrichment in experimental MS models showed beneficial effects mediated by both immune modulation and activity-dependent plasticity, lowering tissue destruction and restoring of CNS network function. Translational researches in MS people demonstrated structural and/or functional MRI changes after various interventions, but their heterogeneity and small sample sizes (5-42 patients) raise concerns about the interpretation and generalization of the obtained results.
We highlighted the limitations of published studies, focusing on the knowledge gaps to be filled in terms of neuropathological correlations between changes detected in animal models and changes detected in vivo by neuroimaging.
神经可塑性是中枢神经系统（CNS）受损后重新学习失去的行为的基础，这是对康复的反应。因此，在多发性硬化症（MS）患者中，康复可以利用神经可塑性的潜力来恢复 CNS 功能，超越 MS 相关损伤的自发恢复机制。
在这里，我们回顾了目前关于康复后结构和功能可塑性机制发生的现有证据，包括运动和/或认知训练。我们既展示了来自动物模型基础实验室研究的数据，也展示了通过先进的磁共振成像（MRI）技术在 MS 患者中获得的数据。
在实验性 MS 模型中进行的身体和环境强化研究表明，免疫调节和活动依赖性可塑性都介导了有益的效果，降低了组织破坏并恢复了 CNS 网络功能。MS 人群的转化研究表明，各种干预措施后存在结构和/或功能 MRI 变化，但它们的异质性和小样本量（5-42 例患者）引起了对获得结果的解释和推广的关注。
我们强调了已发表研究的局限性，重点关注在动物模型中检测到的变化与神经影像学在体内检测到的变化之间的神经病理学相关性方面的知识差距。
