Conti Emilia, Scaglione Alessandro, de Vito Giuseppe, Calugi Francesco, Pasquini Maria, Pizzorusso Tommaso, Micera Silvestro, Allegra Mascaro Anna Letizia, Pavone Francesco Saverio
Neuroscience Institute, 9327National Research Council, Pisa, Italy.
226476European Laboratory for Non-linear Spectroscopy University of Florence, Florence, Italy.
Neurorehabil Neural Repair. 2022 Feb;36(2):107-118. doi: 10.1177/15459683211056656. Epub 2021 Nov 11.
. An ischemic stroke is followed by the remapping of motor representation and extensive changes in cortical excitability involving both hemispheres. Although stimulation of the ipsilesional motor cortex, especially when paired with motor training, facilitates plasticity and functional restoration, the remapping of motor representation of the single and combined treatments is largely unexplored. . We investigated if spatio-temporal features of motor-related cortical activity and the new motor representations are related to the rehabilitative treatment or if they can be specifically associated to functional recovery. . We designed a novel rehabilitative treatment that combines neuro-plasticizing intervention with motor training. In detail, optogenetic stimulation of peri-infarct excitatory neurons expressing Channelrhodopsin 2 was associated with daily motor training on a robotic device. The effectiveness of the combined therapy was compared with spontaneous recovery and with the single treatments (ie optogenetic stimulation or motor training). . We found that the extension and localization of the new motor representations are specific to the treatment, where most treatments promote segregation of the motor representation to the peri-infarct region. Interestingly, only the combined therapy promotes both the recovery of forelimb functionality and the rescue of spatio-temporal features of motor-related activity. Functional recovery results from a new excitatory/inhibitory balance between hemispheres as revealed by the augmented motor response flanked by the increased expression of parvalbumin positive neurons in the peri-infarct area. . Our findings highlight that functional recovery and restoration of motor-related neuronal activity are not necessarily coupled during post-stroke recovery. Indeed the reestablishment of cortical activation features of calcium transient is distinctive of the most effective therapeutic approach, the combined therapy.
缺血性中风后会发生运动表征的重新映射以及涉及双侧半球的皮质兴奋性广泛变化。尽管刺激患侧运动皮层,尤其是与运动训练相结合时,有助于可塑性和功能恢复,但单一治疗和联合治疗的运动表征重新映射在很大程度上尚未得到探索。我们研究了与运动相关的皮质活动的时空特征和新的运动表征是否与康复治疗相关,或者它们是否可以与功能恢复具体相关联。我们设计了一种将神经可塑性干预与运动训练相结合的新型康复治疗方法。具体而言,对表达通道视紫红质2的梗死周围兴奋性神经元进行光遗传学刺激,并与在机器人设备上的日常运动训练相结合。将联合治疗的有效性与自发恢复以及单一治疗(即光遗传学刺激或运动训练)进行比较。我们发现新运动表征的范围和定位因治疗而异,大多数治疗促进运动表征向梗死周围区域的分离。有趣的是,只有联合治疗既促进前肢功能的恢复,又挽救与运动相关活动的时空特征。功能恢复源于半球之间新的兴奋/抑制平衡,梗死周围区域小白蛋白阳性神经元表达增加两侧的增强运动反应揭示了这一点。我们的研究结果强调,中风后恢复期间功能恢复和与运动相关的神经元活动恢复不一定相关。事实上,钙瞬变的皮质激活特征的重建是最有效的治疗方法——联合治疗的独特之处。