Role of the Contralesional Hemisphere in Post-Stroke Recovery of Upper Extremity Motor Function.
Role of the Contralesional Hemisphere in Post-Stroke Recovery of Upper Extremity Motor Function.
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DOI：
10.3389/fneur.2015.00214
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发表时间：
2015
影响因子：
3.4
通讯作者：
Buetefisch CM
中科院分区：
文献类型：
--
作者：
Buetefisch CM
识别最佳的治疗策略，以提高恢复是有限的恢复的神经生物学原理的不完全理解。受损半球（同侧M1）的运动皮层（M1）重组在卒中后运动恢复中起着重要作用，并且是康复治疗的主要目标。然而，卒中对侧半球M1的重组（对侧病灶M1）可能是皮层重组和相关恢复的额外来源。这种重组的程度和结果取决于许多因素，包括病变大小和卒中后的时间。在中风后的慢性期，对侧病灶M1似乎干扰了一部分患者的瘫痪肢体的运动功能，可能是通过对侧病灶M1对受损M1的抑制异常增加。在这些患者中，通过皮层刺激降低对侧M1兴奋性可改善瘫痪肢体的表现。然而，新出现的证据表明，对侧病灶M1的潜在支持作用。M1或其皮质脊髓投射梗死后，对侧M1的兴奋性神经活动和激活异常增加，与良好的运动恢复相关。降低对侧M1的兴奋性，这些患者可能会导致瘫痪肢体的性能恶化。在动物中风模型中，对侧病灶M1的重组变化取决于病灶大小和康复治疗，包括神经递质系统、树突生长和突触形成的长期变化。因此，虽然有一些证据表明，对侧病灶M1的活动将影响中风后亚急性和慢性阶段的瘫痪肢体运动功能的程度，并可能作为康复治疗策略的新目标，但具体影响其在恢复过程中的作用的确切因素仍有待确定。
Identification of optimal treatment strategies to improve recovery is limited by the incomplete understanding of the neurobiological principles of recovery. Motor cortex (M1) reorganization of the lesioned hemisphere (ipsilesional M1) plays a major role in post-stroke motor recovery and is a primary target for rehabilitation therapy. Reorganization of M1 in the hemisphere contralateral to the stroke (contralesional M1) may, however, serve as an additional source of cortical reorganization and related recovery. The extent and outcome of such reorganization depends on many factors, including lesion size and time since stroke. In the chronic phase post-stroke, contralesional M1 seems to interfere with motor function of the paretic limb in a subset of patients, possibly through abnormally increased inhibition of lesioned M1 by the contralesional M1. In such patients, decreasing contralesional M1 excitability by cortical stimulation results in improved performance of the paretic limb. However, emerging evidence suggests a potentially supportive role of contralesional M1. After infarction of M1 or its corticospinal projections, there is abnormally increased excitatory neural activity and activation in contralesional M1 that correlates with favorable motor recovery. Decreasing contralesional M1 excitability in these patients may result in deterioration of paretic limb performance. In animal stroke models, reorganizational changes in contralesional M1 depend on the lesion size and rehabilitation treatment and include long-term changes in neurotransmitter systems, dendritic growth, and synapse formation. While there is, therefore, some evidence that activity in contralesional M1 will impact the extent of motor function of the paretic limb in the subacute and chronic phase post-stroke and may serve as a new target for rehabilitation treatment strategies, the precise factors that specifically influence its role in the recovery process remain to be defined.