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去本地化主义的死亡:通过清醒映射解码功能连接组和神经可塑性的概念,及其对脑损伤患者最佳护理的影响。

The death of localizationism: The concepts of functional connectome and neuroplasticity deciphered by awake mapping, and their implications for best care of brain-damaged patients.

机构信息

Department of Neurosurgery, Gui-de-Chauliac Hospital, Montpellier University Medical Center, 80, avenue Augustin-Fliche, 34295 Montpellier, France; National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Team "Brain Plasticity, Stem Cells and Low-Grade Gliomas", Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France.

出版信息

Rev Neurol (Paris). 2021 Nov;177(9):1093-1103. doi: 10.1016/j.neurol.2021.07.016. Epub 2021 Sep 23.

Abstract

Although clinical neurology was mainly erected on the dogma of localizationism, numerous reports have described functional recovery after lesions involving presumed non-compensable areas in an inflexible view of brain processing. Here, the purpose is to review new insights into the functional connectome and the mechanisms underpinning neural plasticity, gained from intraoperative direct electrostimulation mapping and real-time behavioral monitoring in awake patients, combined with perioperative neuropsychological and neuroimaging data. Such longitudinal anatomo-functional correlations resulted in the reappraisal of classical models of cognition, especially by highlighting the dynamic interplay within and between neural circuits, leading to the concept of meta-network (network of networks), as well as by emphasizing that subcortical connectivity is the main limitation of neuroplastic potential. Beyond their contribution to basic neurosciences, these findings might also be helpful for an optimization of care for brain-damaged patients, such as in resective oncological or epilepsy neurosurgery in structures traditionally deemed inoperable (e.g., in Broca's area) as well as for elaborating new programs of functional rehabilitation, eventually combined with transcranial brain stimulation, aiming to change the connectivity patterns in order to enhance cognitive competences following cerebral injury.

摘要

尽管临床神经病学主要建立在定位主义的教条之上,但大量报告描述了在僵化的大脑处理观点下,涉及假定不可补偿区域的病变后的功能恢复。在这里,目的是回顾从清醒患者术中直接电刺激映射和实时行为监测、结合围手术期神经心理学和神经影像学数据中获得的功能连接组和神经可塑性机制的新见解。这些纵向解剖-功能相关性导致了对经典认知模型的重新评估,特别是通过突出神经回路内部和之间的动态相互作用,导致了元网络(网络的网络)的概念,以及强调皮质下连接是神经可塑性潜力的主要限制。除了对基础神经科学的贡献外,这些发现还可能有助于优化脑损伤患者的护理,例如在传统上被认为不可手术的结构(如布罗卡区)进行肿瘤或癫痫神经外科手术,以及制定新的功能康复计划,最终与经颅脑刺激相结合,旨在改变连接模式,以增强脑损伤后的认知能力。

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