51
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Sommer CJ, Schäbitz WR. Fostering Poststroke Recovery. Stroke 2017; 48:1112-1119. [DOI: 10.1161/strokeaha.116.013324] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Clemens J. Sommer
- From the Institute of Neuropathology, Focus Program Translational Neuroscience (FTN) and Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany (C.J.S.); and Department of Neurology, Bethel, EVKB, University of Munster, Germany (W.-R.S.)
| | - Wolf-Rüdiger Schäbitz
- From the Institute of Neuropathology, Focus Program Translational Neuroscience (FTN) and Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany (C.J.S.); and Department of Neurology, Bethel, EVKB, University of Munster, Germany (W.-R.S.)
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52
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Abstract
Stroke is the leading cause of complex adult disability in the world. Recovery from stroke is often incomplete, which leaves many people dependent on others for their care. The improvement of long-term outcomes should, therefore, be a clinical and research priority. As a result of advances in our understanding of the biological mechanisms involved in recovery and repair after stroke, therapeutic opportunities to promote recovery through manipulation of poststroke plasticity have never been greater. This work has almost exclusively been carried out in preclinical animal models of stroke with little translation into human studies. The challenge ahead is to develop a mechanistic understanding of recovery from stroke in humans. Advances in neuroimaging techniques now enable us to reconcile behavioural accounts of recovery with molecular and cellular changes. Consequently, clinical trials can be designed in a stratified manner that takes into account when an intervention should be delivered and who is most likely to benefit. This approach is expected to lead to a substantial change in how restorative therapeutic strategies are delivered in patients after stroke.
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53
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Cortes JC, Goldsmith J, Harran MD, Xu J, Kim N, Schambra HM, Luft AR, Celnik P, Krakauer JW, Kitago T. A Short and Distinct Time Window for Recovery of Arm Motor Control Early After Stroke Revealed With a Global Measure of Trajectory Kinematics. Neurorehabil Neural Repair 2017; 31:552-560. [PMID: 28506149 DOI: 10.1177/1545968317697034] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Studies demonstrate that most arm motor recovery occurs within three months after stroke, when measured with standard clinical scales. Improvements on these measures, however, reflect a combination of recovery in motor control, increases in strength, and acquisition of compensatory strategies. OBJECTIVE To isolate and characterize the time course of recovery of arm motor control over the first year poststroke. METHODS Longitudinal study of 18 participants with acute ischemic stroke. Motor control was evaluated using a global kinematic measure derived from a 2-dimensional reaching task designed to minimize the need for antigravity strength and prevent compensation. Arm impairment was evaluated with the Fugl-Meyer Assessment of the upper extremity (FMA-UE), activity limitation with the Action Research Arm Test (ARAT), and strength with biceps dynamometry. Assessments were conducted at: 1.5, 5, 14, 27, and 54 weeks poststroke. RESULTS Motor control in the paretic arm improved up to week 5, with no further improvement beyond this time point. In contrast, improvements in the FMA-UE, ARAT, and biceps dynamometry continued beyond 5 weeks, with a similar magnitude of improvement between weeks 5 and 54 as the one observed between weeks 1.5 and 5. CONCLUSIONS Recovery after stroke plateaued much earlier for arm motor control, isolated with a global kinematic measure, compared to motor function assessed with clinical scales. This dissociation between the time courses of kinematic and clinical measures of recovery may be due to the contribution of strength improvement to the latter. Novel interventions, focused on the first month poststroke, will be required to exploit the narrower window of spontaneous recovery for motor control.
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Affiliation(s)
- Juan C Cortes
- 1 Depts. of Neurology, Neuroscience, and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jeff Goldsmith
- 1 Depts. of Neurology, Neuroscience, and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Michelle D Harran
- 1 Depts. of Neurology, Neuroscience, and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jing Xu
- 2 Mailman School of Public Health, Columbia University, New York, NY
| | - Nathan Kim
- 2 Mailman School of Public Health, Columbia University, New York, NY
| | | | - Andreas R Luft
- 2 Mailman School of Public Health, Columbia University, New York, NY
| | - Pablo Celnik
- 2 Mailman School of Public Health, Columbia University, New York, NY
| | - John W Krakauer
- 2 Mailman School of Public Health, Columbia University, New York, NY
| | - Tomoko Kitago
- 1 Depts. of Neurology, Neuroscience, and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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54
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Abstract
We examined the patterns and variability of recovery post-stroke in
multiple behavioral domains. A large cohort of first time stroke patients with
heterogeneous lesions was studied prospectively and longitudinally at 1-2 weeks,
3 months and one year post-injury with structural MRI to measure lesion anatomy
and in-depth neuropsychological assessment. Impairment was described at all
timepoints by a few clusters of correlated deficits. The time course and
magnitude of recovery was similar across domains, with change scores largely
proportional to the initial deficit and most recovery occurring within the first
three months. Damage to specific white matter tracts produced poorer recovery
over several domains: attention and superior longitudinal fasciculus II/III,
language and posterior arcuate fasciculus, motor and corticospinal tract.
Finally, after accounting for the severity of the initial deficit, language and
visual memory recovery/outcome was worse with lower education, while the
occurrence of multiple deficits negatively impacted attention recovery.
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55
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Alia C, Spalletti C, Lai S, Panarese A, Micera S, Caleo M. Reducing GABA A-mediated inhibition improves forelimb motor function after focal cortical stroke in mice. Sci Rep 2016; 6:37823. [PMID: 27897203 PMCID: PMC5126677 DOI: 10.1038/srep37823] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022] Open
Abstract
A deeper understanding of post-stroke plasticity is critical to devise more effective pharmacological and rehabilitative treatments. The GABAergic system is one of the key modulators of neuronal plasticity, and plays an important role in the control of “critical periods” during brain development. Here, we report a key role for GABAergic inhibition in functional restoration following ischemia in the adult mouse forelimb motor cortex. After stroke, the majority of cortical sites in peri-infarct areas evoked simultaneous movements of forelimb, hindlimb and tail, consistent with a loss of inhibitory signalling. Accordingly, we found a delayed decrease in several GABAergic markers that accompanied cortical reorganization. To test whether reductions in GABAergic signalling were causally involved in motor improvements, we treated animals during an early post-stroke period with a benzodiazepine inverse agonist, which impairs GABAA receptor function. We found that hampering GABAA signalling led to significant restoration of function in general motor tests (i.e., gridwalk and pellet reaching tasks), with no significant impact on the kinematics of reaching movements. Improvements were persistent as they remained detectable about three weeks after treatment. These data demonstrate a key role for GABAergic inhibition in limiting motor improvements after cortical stroke.
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Affiliation(s)
- Claudia Alia
- Scuola Normale Superiore, 56126, Pisa, Italy.,CNR Neuroscience Institute, 56124, Pisa, Italy
| | | | - Stefano Lai
- The BioRobotics Institute Scuola Superiore Sant'Anna, 56025, Pontedera (PI), Italy
| | - Alessandro Panarese
- The BioRobotics Institute Scuola Superiore Sant'Anna, 56025, Pontedera (PI), Italy
| | - Silvestro Micera
- The BioRobotics Institute Scuola Superiore Sant'Anna, 56025, Pontedera (PI), Italy.,Ecole Polytechnique Federale de Lausanne (EPFL), Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, CH-1015 Lausanne, Switzerland
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56
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Schambra H, Im B, O'Dell MW. Should This Patient With Ischemic Stroke Receive Fluoxetine? PM R 2016; 7:1294-1299. [PMID: 26709246 DOI: 10.1016/j.pmrj.2015.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Heidi Schambra
- Department of Rehabilitation & Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Brian Im
- Rusk Rehabilitation, NYU Langone Medical Center, New York, NY
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E. 68th St. F-1602, New York, NY 10021
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57
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Byblow W, Schlaug G, Wittenberg G. What's the perfect dose for practice to make perfect? Ann Neurol 2016; 80:339-41. [PMID: 27447540 DOI: 10.1002/ana.24735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Winston Byblow
- Department of Exercise Sciences and Centre for Brain Research, University of Auckland, Auckland, New Zealand.,Department of Neurology, Division of Stroke Recovery and Neurorestoration, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Gottfried Schlaug
- Department of Neurology, Division of Stroke Recovery and Neurorestoration, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - George Wittenberg
- Maryland Exercise and Robotics Center of Excellence, Geriatrics Research Educational and Clinical Center, Department of Veterans Affairs, Baltimore, MD.,Laboratory for Research on Arm Function and Therapy, Older Americans Independence Center, Departments of Neurology, Physical Therapy and Rehabilitation Science, and Medicine/Division of Gerontology and Geriatric Medicine, University of Maryland, Baltimore, MD.,Departments of Neurology, Physical Therapy and Rehabilitation Science, and Medicine/Division of Gerontology and Geriatric Medicine, University of Maryland, Baltimore, MD
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58
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Sanchez-Mendoza EH, Hermann DM. Correlates of Post-Stroke Brain Plasticity, Relationship to Pathophysiological Settings and Implications for Human Proof-of-Concept Studies. Front Cell Neurosci 2016; 10:196. [PMID: 27547178 PMCID: PMC4974253 DOI: 10.3389/fncel.2016.00196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 01/01/2023] Open
Abstract
The promotion of neurological recovery by enhancing neuroplasticity has recently obtained strong attention in the stroke field. Experimental studies support the hypothesis that stroke recovery can be improved by therapeutic interventions that augment neuronal sprouting. However plasticity responses of neurons are highly complex, involving the growth and differentiation of axons, dendrites, dendritic spines and synapses, which depend on the pathophysiological setting and are tightly controlled by extracellular and intracellular signals. Thorough mechanistic insights are needed into how neuronal plasticity is influenced by plasticity-promoting therapies in order not to risk the success of future clinical proof-of-concept studies.
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59
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Tizabi Y. Duality of Antidepressants and Neuroprotectants. Neurotox Res 2016; 30:1-13. [PMID: 26613895 PMCID: PMC4884174 DOI: 10.1007/s12640-015-9577-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 12/14/2022]
Abstract
The co-morbidity of neuropsychiatric disorders, particularly major depressive disorder (MDD) with neurodegenerative diseases, in particular Parkinson's disease (PD) is now well recognized. Indeed, it is suggested that depressive disorders, especially in late life, may be an indication of latent neurodegeneration. Thus, it is not unreasonable to expect that deterrents of MDD may also deter the onset and/or progression of the neurodegenerative diseases including PD. In this review, examples of neuroprotective efficacy of established as well as prospective antidepressants are provided. Conversely, mood-regulating effects of some neuroprotective drugs are also presented. Thus, in addition to currently used antidepressants, ketamine, nicotine, curcumin, and resveratrol are discussed for their dual efficacy. In addition, potential neurobiological substrates for their actions are presented. It is concluded that pharmacological developments of mood-regulating or neuroprotective drugs can have cross benefit in co-morbid conditions of neuropsychiatric and neurodegenerative disorders and that inflammatory and neurotrophic factors play important roles in both conditions.
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Affiliation(s)
- Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA.
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60
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Reinkensmeyer DJ, Burdet E, Casadio M, Krakauer JW, Kwakkel G, Lang CE, Swinnen SP, Ward NS, Schweighofer N. Computational neurorehabilitation: modeling plasticity and learning to predict recovery. J Neuroeng Rehabil 2016; 13:42. [PMID: 27130577 PMCID: PMC4851823 DOI: 10.1186/s12984-016-0148-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/13/2016] [Indexed: 01/19/2023] Open
Abstract
Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning that such models will incorporate. We proceed by discussing how computational neurorehabilitation models relate to the current benchmark in rehabilitation modeling - regression-based, prognostic modeling. We then critically discuss the first computational neurorehabilitation models, which have primarily focused on modeling rehabilitation of the upper extremity after stroke, and show how even simple models have produced novel ideas for future investigation. Finally, we conclude with key directions for future research, anticipating that soon we will see the emergence of mechanistic models of motor recovery that are informed by clinical imaging results and driven by the actual movement content of rehabilitation therapy as well as wearable sensor-based records of daily activity.
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Affiliation(s)
- David J Reinkensmeyer
- Departments of Anatomy and Neurobiology, Mechanical and Aerospace Engineering, Biomedical Engineering, and Physical Medicine and Rehabilitation, University of California, Irvine, USA.
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Maura Casadio
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - John W Krakauer
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Catherine E Lang
- Department of Neurology, Program in Physical Therapy, Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Stephan P Swinnen
- Department of Kinesiology, KU Leuven Movement Control & Neuroplasticity Research Group, Leuven, KU, Belgium
- Leuven Research Institute for Neuroscience & Disease (LIND), KU, Leuven, Belgium
| | - Nick S Ward
- Sobell Department of Motor Neuroscience and UCLPartners Centre for Neurorehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
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61
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Fluoxetine protects against IL-1β-induced neuronal apoptosis via downregulation of p53. Neuropharmacology 2016; 107:68-78. [PMID: 26976669 DOI: 10.1016/j.neuropharm.2016.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/02/2016] [Accepted: 03/10/2016] [Indexed: 12/23/2022]
Abstract
Fluoxetine, a selective serotonin reuptake inhibitor, exerts neuroprotective effects in a variety of neurological diseases including stroke, but the underlying mechanism remains obscure. In the present study, we addressed the molecular events in fluoxetine against ischemia/reperfusion-induced acute neuronal injury and inflammation-induced neuronal apoptosis. We showed that treatment of fluoxetine (40 mg/kg, i.p.) with twice injections at 1 h and 12 h after transient middle cerebral artery occlusion (tMCAO) respectively alleviated neurological deficits and neuronal apoptosis in a mouse ischemic stroke model, accompanied by inhibiting interleukin-1β (IL-1β), Bax and p53 expression and upregulating anti-apoptotic protein Bcl-2 level. We next mimicked neuroinflammation in ischemic stroke with IL-1β in primary cultured cortical neurons and found that pretreatment with fluoxetine (1 μM) prevented IL-1β-induced neuronal apoptosis and upregulation of p53 expression. Furthermore, we demonstrated that p53 overexpression in N2a cell line abolished the anti-apoptotic effect of fluoxetine, indicating that p53 downregulation is required for the protective role of fluoxetine in IL-1β-induced neuronal apoptosis. Fluoxetine downregulating p53 expression could be mimicked by SB203580, a specific inhibitor of p38, but blocked by anisomycin, a p38 activator. Collectively, our findings have revealed that fluoxetine protects against IL-1β-induced neuronal apoptosis via p38-p53 dependent pathway, which give us an insight into the potential of fluoxetine in terms of opening up novel therapeutic avenues for neurological diseases including stroke.
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62
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Campos AC, Fogaça MV, Sonego AB, Guimarães FS. Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacol Res 2016; 112:119-127. [PMID: 26845349 DOI: 10.1016/j.phrs.2016.01.033] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 12/31/2022]
Abstract
Cannabidiol (CBD) is a non-psychotomimetic phytocannabinoid derived from Cannabis sativa. It has possible therapeutic effects over a broad range of neuropsychiatric disorders. CBD attenuates brain damage associated with neurodegenerative and/or ischemic conditions. It also has positive effects on attenuating psychotic-, anxiety- and depressive-like behaviors. Moreover, CBD affects synaptic plasticity and facilitates neurogenesis. The mechanisms of these effects are still not entirely clear but seem to involve multiple pharmacological targets. In the present review, we summarized the main biochemical and molecular mechanisms that have been associated with the therapeutic effects of CBD, focusing on their relevance to brain function, neuroprotection and neuropsychiatric disorders.
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Affiliation(s)
- Alline C Campos
- Department of Pharmacology, Medical School of of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil; Center of Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil.
| | - Manoela V Fogaça
- Department of Pharmacology, Medical School of of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil; Center of Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Andreza B Sonego
- Department of Pharmacology, Medical School of of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil; Center of Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Francisco S Guimarães
- Department of Pharmacology, Medical School of of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil; Center of Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
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63
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Zeiler SR, Hubbard R, Gibson EM, Zheng T, Ng K, O'Brien R, Krakauer JW. Paradoxical Motor Recovery From a First Stroke After Induction of a Second Stroke: Reopening a Postischemic Sensitive Period. Neurorehabil Neural Repair 2015; 30:794-800. [PMID: 26721868 DOI: 10.1177/1545968315624783] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Prior studies have suggested that after stroke there is a time-limited period of increased responsiveness to training as a result of heightened plasticity-a sensitive period thought to be induced by ischemia itself. Using a mouse model, we have previously shown that most training-associated recovery after a caudal forelimb area (CFA) stroke occurs in the first week and is attributable to reorganization in a medial premotor area (AGm). The existence of a stroke-induced sensitive period leads to the counterintuitive prediction that a second stroke should reopen this window and promote full recovery from the first stroke. To test this prediction, we induced a second stroke in the AGm of mice with incomplete recovery after a first stroke in CFA. METHODS Mice were trained to perform a skilled prehension (reach-to-grasp) task to an asymptotic level of performance, after which they underwent photocoagulation-induced stroke in CFA. After a 7-day poststroke delay, the mice were then retrained to asymptote. We then induced a second stroke in the AGm, and after only a 1-day delay, retrained the mice. RESULTS Recovery of prehension was incomplete when training was started after a 7-day poststroke delay and continued for 19 days. However, a second focal stroke in the AGm led to a dramatic response to 9 days of training, with full recovery to normal levels of performance. CONCLUSIONS New ischemia can reopen a sensitive period of heightened responsiveness to training and mediate full recovery from a previous stroke.
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Affiliation(s)
| | | | | | - Tony Zheng
- Johns Hopkins University, Baltimore, MD, USA
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64
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Krakauer JW, Marshall RS. The proportional recovery rule for stroke revisited. Ann Neurol 2015; 78:845-7. [DOI: 10.1002/ana.24537] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/07/2022]
Affiliation(s)
- JW Krakauer
- Department of Neurology; The Johns Hopkins University School of Medicine; Baltimore MD
| | - RS Marshall
- Department of Neurology; Columbia University Medical Center; New York NY
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