Univ. Grenoble Alpes, CNRS, LPNC, 38000 Grenoble, France.
Hôpital Fondation Adolphe de Rothschild, Service de Neurochirurgie Pédiatrique, 75019 Paris, France.
Rev Neurosci. 2024 May 16;35(7):747-774. doi: 10.1515/revneuro-2024-0009. Print 2024 Oct 28.
Rasmussen's encephalitis is a rare neurological pathology affecting one cerebral hemisphere, therefore, posing unique challenges. Patients may undergo hemispherectomy, a surgical procedure after which cognitive development occurs in the isolated contralateral hemisphere. This rare situation provides an excellent opportunity to evaluate brain plasticity and cognitive recovery at a hemispheric level. This literature review synthesizes the existing body of research on cognitive recovery following hemispherectomy in Rasmussen patients, considering cognitive domains and modulatory factors that influence cognitive outcomes. While language function has traditionally been the focus of postoperative assessments, there is a growing acknowledgment of the need to broaden the scope of language investigation in interaction with other cognitive domains and to consider cognitive scaffolding in development and recovery. By synthesizing findings reported in the literature, we delineate how language functions may find support from the right hemisphere after left hemispherectomy, but also how, beyond language, global cognitive functioning is affected. We highlight the critical influence of several factors on postoperative cognitive outcomes, including the timing of hemispherectomy and the baseline preoperative cognitive status, pointing to early surgical intervention as predictive of better cognitive outcomes. However, further specific studies are needed to confirm this correlation. This review aims to emphasize a better understanding of mechanisms underlying hemispheric specialization and plasticity in humans, which are particularly important for both clinical and research advancements. This narrative review underscores the need for an integrative approach based on cognitive scaffolding to provide a comprehensive understanding of mechanisms underlying the reorganization in Rasmussen patients after hemispherectomy.
拉森姆氏脑炎是一种罕见的影响大脑单侧半球的神经病理学疾病，因此带来了独特的挑战。患者可能需要接受半球切除术，这是一种在孤立的对侧半球上进行的手术。这种罕见的情况为评估半球水平的大脑可塑性和认知恢复提供了极好的机会。本文对拉森姆氏脑炎患者行半球切除术之后认知恢复的现有研究进行综述，考虑了影响认知结果的认知领域和调节因素。虽然语言功能一直是术后评估的重点，但人们越来越认识到需要拓宽语言研究的范围，使其与其他认知领域相互作用，并考虑认知支架在发展和恢复中的作用。通过综合文献中报道的研究结果，我们描绘了语言功能在左半球手术后如何可能得到右半球的支持，但也描绘了除语言之外，整体认知功能是如何受到影响的。我们强调了几个因素对术后认知结果的关键影响，包括半球切除术的时机和术前认知状态的基线，表明早期手术干预对认知结果有更好的预测作用。然而，还需要进一步的具体研究来证实这一相关性。本文综述旨在强调对人类半球专门化和可塑性机制的更好理解，这对于临床和研究进展都非常重要。本综述强调了需要基于认知支架的综合方法来提供对拉森姆氏脑炎患者半球切除术之后重组机制的全面理解。
