Consensus Paper. Cerebellar Reserve: From Cerebellar Physiology to Cerebellar Disorders
Consensus Paper. Cerebellar Reserve: From Cerebellar Physiology to Cerebellar Disorders
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DOI：
10.1007/s12311-019-01091-9
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发表时间：
2019-12-26
期刊：
影响因子：
3.5
通讯作者：
Schmahmann, J. D.
中科院分区：
文献类型：
--
作者：
Mitoma, H.;Buffo, A.;Schmahmann, J. D.
小脑储备是指小脑补偿由许多不同病因引起的组织损伤或功能丧失的能力。当刺激事件产生急性局灶性损伤（例如中风、创伤）时，受损的小脑功能可以通过其他小脑区域或小脑外结构（即结构性小脑储备）来补偿。相反，当病理变化损害小脑神经元完整性并逐渐导致细胞死亡时（例如，代谢和免疫介导的小脑共济失调、神经退行性共济失调），受影响的区域本身可能可以补偿缓慢发展的小脑病变（即功能性小脑储备）。在这里，我们从临床共济失调学的三个基石的角度检查小脑储备：眼球运动的控制、随意轴和四肢运动的协调以及认知功能。目前的证据表明，小脑储备通过自噬和突触发生机制受到环境富集的增强，这表明小脑储备不是刚性或固定的，而是表现出通过经验增强的可塑性。这些结论具有治疗意义。在保留小脑储备期间，治疗应旨在阻止疾病进展和/或限制病理过程。同时，可以使用多种方法增强小脑储备。小脑储备的增强可能会导致小脑疾病中的功能代偿和恢复，并且还可以通过增强小脑的作用机制来导致主要大脑半球的疾病。因此，小脑储备以及小脑微电路的潜在可塑性似乎对广泛的神经/神经精神疾病具有至关重要的神经生物学重要性。
Cerebellar reserve refers to the capacity of the cerebellum to compensate for tissue damage or loss of function resulting from many different etiologies. When the inciting event produces acute focal damage (e.g., stroke, trauma), impaired cerebellar function may be compensated for by other cerebellar areas or by extracerebellar structures (i.e., structural cerebellar reserve). In contrast, when pathological changes compromise cerebellar neuronal integrity gradually leading to cell death (e.g., metabolic and immune-mediated cerebellar ataxias, neurodegenerative ataxias), it is possible that the affected area itself can compensate for the slowly evolving cerebellar lesion (i.e., functional cerebellar reserve). Here, we examine cerebellar reserve from the perspective of the three cornerstones of clinical ataxiology: control of ocular movements, coordination of voluntary axial and appendicular movements, and cognitive functions. Current evidence indicates that cerebellar reserve is potentiated by environmental enrichment through the mechanisms of autophagy and synaptogenesis, suggesting that cerebellar reserve is not rigid or fixed, but exhibits plasticity potentiated by experience. These conclusions have therapeutic implications. During the period when cerebellar reserve is preserved, treatments should be directed at stopping disease progression and/or limiting the pathological process. Simultaneously, cerebellar reserve may be potentiated using multiple approaches. Potentiation of cerebellar reserve may lead to compensation and restoration of function in the setting of cerebellar diseases, and also in disorders primarily of the cerebral hemispheres by enhancing cerebellar mechanisms of action. It therefore appears that cerebellar reserve, and the underlying plasticity of cerebellar microcircuitry that enables it, may be of critical neurobiological importance to a wide range of neurological/neuropsychiatric conditions.