Task-induced brain activity in aphasic stroke patients: what is driving recovery?
Task-induced brain activity in aphasic stroke patients: what is driving recovery?
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DOI：
10.1093/brain/awu163
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Wise RJ
中科院分区：
文献类型：
--
作者：
Geranmayeh F;Brownsett SL;Wise RJ
基于对已发表的功能性神经影像学和临床神经心理学数据的解释和重新解释，Geranmayeh等人认为，失语性卒中的恢复可能与语言特异性网络的恢复一样多地归因于高阶、领域通用网络的功能。这种区别对康复有影响。在英国和美国，失语症的估计患病率分别为250 000和1 000 000。最常见的病因是中风。行为疗法可能会改善这种损害，使用皮层刺激或药物疗法的试验正在进行原理验证调查，但结果好坏参半。失语症是一种异质性综合征，根据Broca-Wernicke-Lichtheim模型的简单分类不足以描述患者可能存在的各种沟通困难。更好地了解完整的神经网络如何促进失语症卒中后的恢复，无论是自发的还是对干预的反应，将导致关于如何改善失语症治疗的更清晰的假设。25年前，一项关于健康参与者的开创性研究预示着将功能性神经影像学引入失语症恢复机制的研究。在随后的几十年里，这些研究被解释为支持三个假设之一，这三个假设并不相互排斥。前两个早于功能性神经影像学的引入：恢复是特定领域的语言系统在病变周围组织中重建的结果（“病灶周围”假说），或对侧半球的同位皮层（“侧移”假说）。第三种是对侧同伦皮层的跨胼胝体抑制的丧失阻碍了恢复（“去抑制”假说）。这些不同的假设有时会对康复干预产生相互矛盾的观点;例如，应该尝试用皮层刺激技术激活或抑制对侧同伦区域以促进康复吗？这篇综述提出，虽然功能成像数据在大多数情况下是统计学上有效的，但它们的解释往往倾向于一种解释，而忽略了合理的替代方案。在我们看来，当恢复归因于“语言网络”占据健康参与者中未观察到的网站的活动时，这一点尤其明显。在这篇评论中，我们将认为，什么往往被解释为语言特异性活动的分布，特别是在中线和对侧皮层区域，是一个上调的活动在完整的域一般系统的认知控制和注意力，响应任务依赖的方式增加“努力”时，受损的下游域特定的语言网络受损。我们进一步提出，无法完全激活这些系统可能会导致某些患者的恢复不佳。在域一般网络的活动方面的数据的解释提供了新的方法来康复的见解。
Based on the interpretation and reinterpretation of published functional neuroimaging and clinical neuropsychological data, Geranmayeh et al. argue that recovery from aphasic stroke may be due as much to the function of high-order, domain-general networks as to recovery of language-specific networks. This distinction has implications for rehabilitation. The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the ‘perilesional’ hypothesis), or by homotopic cortex in the contralateral hemisphere (the ‘laterality-shift’ hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the ‘disinhibition’ hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is attributed to activity in ‘language networks’ occupying sites not observed in healthy participants. In this review we will argue that much of the distribution of what has often been interpreted as language-specific activity, particularly in midline and contralateral cortical regions, is an upregulation of activity in intact domain-general systems for cognitive control and attention, responding in a task-dependent manner to the increased ‘effort’ when damaged downstream domain-specific language networks are impaired. We further propose that it is an inability fully to activate these systems that may result in sub optimal recovery in some patients. Interpretation of the data in terms of activity in domain-general networks affords insights into novel approaches to rehabilitation.
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