Invasive cortical stimulation to promote recovery of function after stroke: a critical appraisal.
Invasive cortical stimulation to promote recovery of function after stroke: a critical appraisal.
复制标题
促进中风后功能恢复的侵入性皮层刺激：一项重要评估。
DOI：
10.1161/strokeaha.108.540823
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发表时间：
2009-05
期刊：
影响因子：
8.3
通讯作者：
Pascual-Leone A
中科院分区：
文献类型：
--
作者：
Plow EB;Carey JR;Nudo RJ;Pascual-Leone A
中风后残留的运动缺陷常常会持续存在。正在寻找更新的有效策略来促进功能恢复。大脑刺激作为引导适应性可塑性的一种手段，很有吸引力。动物研究以及人体 I 期和 II 期试验表明，将康复与并发侵入性皮质刺激相结合的安全性、可行性和有效性。然而，最近的一项 III 期试验显示该组合没有任何优势。我们批判性地审查各种试验的结果，并讨论促成独特结果的因素。关于皮质刺激，重要的是（1）通过整合多种神经解剖学和生理学技术来确定梗塞周围表征的位置； (2)其他中风恢复机制的作用； (3)梗塞周围组织和下行通路的活力； (4) 损伤几何形状，以确保电流密度不会改变/位移； （5）人类无创脑刺激研究得出的经验教训的适用性。在刺激与康复结合方面，我们应该理解（1）稳态可塑性原理； (2) 正在进行的皮质活动和学习阶段的影响； (3) 可能需要针对特定主题进行干预。未来的皮质刺激试验应考虑可能导致 III 期试验特殊结果的因素，并在未来的研究设计中解决这些问题。
Residual motor deficits frequently linger after stroke. Search for newer effective strategies to promote functional recovery is ongoing. Brain stimulation, as a means of directing adaptive plasticity, is appealing. Animal studies and Phase I and II trials in humans have indicated safety, feasibility, and efficacy of combining rehabilitation and concurrent invasive cortical stimulation. However, a recent Phase III trial showed no advantage of the combination. We critically review results of various trials and discuss the factors that contributed to the distinctive result. Regarding cortical stimulation, it is important to determine the (1) location of peri-infarct representations by integrating multiple neuroanatomical and physiological techniques; (2) role of other mechanisms of stroke recovery; (3) viability of peri-infarct tissue and descending pathways; (4) lesion geometry to ensure no alteration/displacement of current density; and (5) applicability of lessons generated from noninvasive brain stimulation studies in humans. In terms of combining stimulation with rehabilitation, we should understand (1) the principle of homeostatic plasticity; (2) the effect of ongoing cortical activity and phases of learning; and (3) that subject-specific intervention may be necessary. Future cortical stimulation trials should consider the factors that may have contributed to the peculiar results of the Phase III trial and address those in future study designs.