Plasticity of the visual cortex after injury: what's different about the young brain?

Robust Visual Responses and Normal Retinotopy in Primate Lateral Geniculate Nucleus following Long-term Lesions of Striate Cortex

Lesions of striate cortex (V1) trigger massive retrograde degeneration of neurons in the LGN. In primates, these lesions also lead to scotomas, within which conscious vision is abolished. Mediation of residual visual capacity within these regions (blindsight) has been traditionally attributed to an indirect visual pathway to the extrastriate cortex, which involves the superior colliculus and pulvinar complex. However, recent studies have suggested that preservation of the LGN is critical for behavioral evidence of blindsight, raising the question of what type of visual information is channeled by remaining neurons in this structure. A possible contribution of LGN neurons to blindsight is predicated on two conditions: that the neurons that survive degeneration remain visually responsive, and that their receptive fields continue to represent the region of the visual field inside the scotoma. We tested these conditions in male and female marmoset monkeys (Callithrix jacchus) with partial V1 lesions at three developmental stages (early postnatal life, young adulthood, old age), followed by long recovery periods. In all cases, recordings from the degenerated LGN revealed neurons with well-formed receptive fields throughout the scotoma. The responses were consistent and robust, and followed the expected eye dominance and retinotopy observed in the normal LGN. The responses had short latencies and preceded those of neurons recorded in the extrastriate middle temporal area. These findings suggest that the pathway that links LGN neurons to the extrastriate cortex is physiologically viable and can support residual vision in animals with V1 lesions incurred at various ages.SIGNIFICANCE STATEMENT Patients with a lesion of the primary visual cortex (V1) can retain certain visually mediated behaviors, particularly if the lesion occurs early in life. This phenomenon ("blindsight") not only sheds light on the nature of consciousness, but also has implications for studies of brain circuitry, development, and plasticity. However, the pathways that mediate blindsight have been the subject of debate. Recent studies suggest that projections from the LGN might be critical, but this finding is puzzling given that the lesions causes severe cell death in the LGN. Here we demonstrate in monkeys that the surviving LGN neurons retain a remarkable level of visual function and could therefore be the source of the visual information that supports blindsight.

Probing Human Visual Deficits with Functional Magnetic Resonance Imaging

Much remains to be understood about visual system malfunction following injury. The resulting deficits range from dense, visual field scotomas to mild dysfunction of visual perception. Despite the predictive value of anatomical localization studies, much patient-to-patient variability remains regarding (a) perceptual abilities following injury and (b) the capacity of individual patients for visual rehabilitation. Visual field perimetry is used to characterize the visual field deficits that result from visual system injury. However, standard perimetry mapping does not always precisely correspond to underlying anatomical or functional deficits. Functional magnetic resonance imaging can be used to probe the function of surviving visual circuits, allowing us to classify better how the pattern of injury relates to residual visual perception. Identifying pathways that are potentially modifiable by training may guide the development of improved strategies for visual rehabilitation. This review discusses primary visual cortex lesions, which cause dense contralateral scotomas.

Population receptive field analysis of the primary visual cortex complements perimetry in patients with homonymous visual field defects

Injury to the primary visual cortex (V1) typically leads to loss of conscious vision in the corresponding, homonymous region of the contralateral visual hemifield (scotoma). Several studies suggest that V1 is highly plastic after injury to the visual pathways, whereas others have called this conclusion into question. We used functional magnetic resonance imaging (fMRI) to measure area V1 population receptive field (pRF) properties in five patients with partial or complete quadrantic visual field loss as a result of partial V1+ or optic radiation lesions. Comparisons were made with healthy controls deprived of visual stimulation in one quadrant ["artificial scotoma" (AS)]. We observed no large-scale changes in spared-V1 topography as the V1/V2 border remained stable, and pRF eccentricity versus cortical-distance plots were similar to those of controls. Interestingly, three observations suggest limited reorganization: (i) the distribution of pRF centers in spared-V1 was shifted slightly toward the scotoma border in 2 of 5 patients compared with AS controls; (ii) pRF size in spared-V1 was slightly increased in patients near the scotoma border; and (iii) pRF size in the contralesional hemisphere was slightly increased compared with AS controls. Importantly, pRF measurements yield information about the functional properties of spared-V1 cortex not provided by standard perimetry mapping. In three patients, spared-V1 pRF maps overlapped significantly with dense regions of the perimetric scotoma, suggesting that pRF analysis may help identify visual field locations amenable to rehabilitation. Conversely, in the remaining two patients, spared-V1 pRF maps failed to cover sighted locations in the perimetric map, indicating the existence of V1-bypassing pathways able to mediate useful vision.

Visually evoked responses in extrastriate area MT after lesions of striate cortex in early life

Lesions of striate cortex [primary visual cortex (V1)] in adult primates result in blindness. In contrast, V1 lesions in neonates typically allow much greater preservation of vision, including, in many human patients, conscious perception. It is presently unknown how this marked functional difference is related to physiological changes in cortical areas that are spared by the lesions. Here we report a study of the middle temporal area (MT) of adult marmoset monkeys that received unilateral V1 lesions within 6 weeks of birth. In contrast with observations after similar lesions in adult monkeys, we found that virtually all neurons in the region of MT that was deprived of V1 inputs showed robust responses to visual stimulation. These responses were very similar to those recorded in neurons with receptive fields outside the lesion projection zones in terms of firing rate, signal-to-noise ratio, and latency. In addition, the normal retinotopic organization of MT was maintained. Nonetheless, we found evidence of a very specific functional deficit: direction selectivity, a key physiological characteristic of MT that is known to be preserved in many cells after adult V1 lesions, was absent. These results demonstrate that lesion-induced reorganization of afferent pathways is sufficient to develop robust visual function in primate extrastriate cortex, highlighting a likely mechanism for the sparing of vision after neonatal V1 lesions. However, they also suggest that interactions with V1 in early postnatal life are critical for establishing stimulus selectivity in MT.

Adaptive neuroplastic responses in early and late hemispherectomized monkeys

Behavioural recovery in children who undergo medically required hemispherectomy showcase the remarkable ability of the cerebral cortex to adapt and reorganize following insult early in life. Case study data suggest that lesions sustained early in childhood lead to better recovery compared to those that occur later in life. In these children, it is possible that neural reorganization had begun prior to surgery but was masked by the dysfunctional hemisphere. The degree of neural reorganization has been difficult to study systematically in human infants. Here we present a 20-year culmination of data on our nonhuman primate model (Chlorocebus sabeus) of early-life hemispherectomy in which behavioral recovery is interpreted in light of plastic processes that lead to the anatomical reorganization of the early-damaged brain. The model presented here suggests that significant functional recovery occurs after the removal of one hemisphere in monkeys with no preexisting neurological dysfunctions. Human and primate studies suggest a critical role for subcortical and brainstem structures as well as corticospinal tracts in the neuroanatomical reorganization which result in the remarkable behavioral recovery following hemispherectomy. The non-human primate model presented here offers a unique opportunity for studying the behavioral and functional neuroanatomical reorganization that underlies developmental plasticity.

What does Neural Plasticity Tell us about Role of Primary Visual Cortex (V1) in Visual Awareness?

The complete loss of visual awareness resulting from a lesion to the primary visual cortex (V1) suggests that this region is indispensable for conscious visual perception. There are however a number cases of conscious perception in the absence of V1 which appear to challenge this conclusion. These include reports of patients with bilateral V1 lesions sustained at an early age whose conscious vision has spontaneously recovered, as well as stroke patients who have recovered some conscious vision with the help of rehabilitation programs. In addition, the phenomenon of hemianopic completion and percepts induced by brain stimulation suggest that V1 may not be necessary for conscious perception in all circumstances. Furthermore, that the visual abilities in the cat are associated with the recovery of normal extrastriate tuning properties rather than emulation of V1 functions suggests that there is nothing unique about the functional properties of this region in visual awareness. Rather, the dramatic effect of a V1 lesion on visual awareness may be due to its role in providing the majority of extrastriate visual input, the loss of which abolishes normal neural responsiveness throughout the visual cortex.

Early brain injury and plasticity: Reorganization and functional Recovery

One of the most remarkable observations in developmental neuroscience is the plasticity of the developing brain. Although recent findings suggest that the developing brain possesses substantial compensatory potential, the mechanisms of reorganization and its limitations remain largely unknown. This review includes studies elucidating the complexities of brain reorganization in response to early brain injury. It describes the factors influencing the pattern and degree of brain plasticity, provides insight into the patterns of reorganization in different brain systems and offers guidelines for clinicians in the field of neurorehabilitation. This knowledge is crucial in clinical work when designing the appropriate type and timing of interventions for children with early brain injuries

Plasticity of the visual system after early brain damage

The aim of this review is to discuss the existing evidence supporting different processes of visual brain plasticity after early damage, as opposed to damage that occurs during adulthood. There is initial evidence that some of the neuroplastic mechanisms adopted by the brain after early damage to the visual system are unavailable at a later stage. These are, for example, the ability to differentiate functional tissue within a larger dysplastic cortex during its formation, or to develop new thalamo-cortical connections able to bypass the lesion and reach their cortical destination in the occipital cortex. The young brain also uses the same mechanisms available at later stages of development but in a more efficient way. For example, in people with visual field defects of central origin, the anatomical expansion of the extrastriatal visual network is greater after an early lesion than after a later one, which results in more efficient mechanisms of visual exploration of the blind field. A similar mechanism is likely to support some of the differences found in people with blindsight, the phenomenon of unconscious visual perception in the blind field. In particular, compared with people with late lesions, those with early brain damage appear to have stronger subjective awareness of stimuli hitting the blind visual field, reported as a conscious feeling that something is present in the visual field. Expanding our knowledge of these mechanisms could help the development of early therapeutic interventions aimed at supporting and enhancing visual reorganization at a time of greatest potential brain plasticity.

Effects of VEGF administration or neutralization on the BBB of developing rat brain

We investigated the effects of exogenous Vascular Endothelial Growth Factor VEGF combined with an enriched environment on BBB integrity after a minimal trauma induced during the first days of the critical visual period in rats, when peak levels of endogenous VEGF secretion are reached. VEGF was administered using osmotic mini-pumps placed in middle cortical layers of P18 Long-Evansrats. Tissue changes were evaluated using conventional histology. BBB integrity was shown by immunohistochemistry techniques for EBA and GluT-1. Mini-pump implantation produced a wider cavity in anti-VEGF infused rats. In VEGF-infused rats there was a damaged region around the cannula that was smaller in rats raised in an enriched environment (EE). The administration of VEGF induced a high concentration of plasma proteins in the neuropil around the point of cannula placement and a high inflammatory reaction. VEGF-infused rats raised in an EE showed a lower degree of extravasation and better tissue preservation. Anti-VEGF administration produced a lower protein expression profile and more widespread deterioration of tissue. Double immunofluorescence for EBA and GluT-1 showed that the administration of VEGF preserves the tissue, which remains present but not fully functional. In contrast, a combination of VEGF administration and an EE partially protects the functionally damaged tissue with a higher preservation of BBB integrity.

The assessment of visual acuity in children with periventricular damage: a comparison of behavioural and electrophysiological techniques

It has been controversial whether electrophysiology offers better precision than behavioural techniques in measuring visual acuity in children with brain damage. We investigated the concordance between sweep VEPs and Acuity Cards (AC) in 29 children with periventricular leukomalacia (PVL), the most common type of brain damage in preterm infants. An overall good correlation was shown but with relatively better behavioural acuity values. VEP/AC ratio was significantly correlated to corpus callosum posterior thinning. We propose that this result reflects the efficacy of the compensatory mechanisms following early brain damage which may differentially affect the two methods.

Recovery of visual functions after early acquired occipital damage

Plasticity of visual systems after early brain damage has been extensively studied in animal models but poorly documented in children after visual pathway lesions. This report describes the visual recovery of a male child who had a bilateral occipital lobe infarction at the age of 2 years 6 months, 10 days after colon resection for Hirschsprung disease. In the acute phase he had severe visual impairment without visual response. Some weeks later he could perceive movement. Since then, progressive recovery of his visual acuity and oculomotor abilities has been accompanied by a progressive reduction of the visual field defect. At 6 years 8 months, visual recognition acuity was 10/10 in both eyes and neuro-ophthalmological examination was normal, except for persistence of the visual field defect in the upper hemifield and a selective impairment of higher visual functions (recognition of object presented in a hard-to-decode way [e.g. overlapping figures], or use of complex visuospatial skills). The functional recovery observed in this patient confirms the adaptive plasticity of developing visual systems after early brain lesions. It suggests that in humans, as in animal models, processes related to cerebral plasticity may take place years after a brain lesion has been sustained.

Relocation of specific visual functions following damage of mature posterior parietal cortex

Many visual deficits have been reported following damage to specific cerebral sites within posterior parietal cortex. These deficits generally involve aspects of vision including spatial or motion perception and visuomotor control. One characteristic of many of these deficits is that they tend to attenuate over time. Presumably, other cortical regions possess adaptive neuroplastic mechanisms that allow them to accommodate functions that were previously dominated by the damaged region. This report summarizes a series of experiments that examined adaptive cortical plasticity following cerebral cortex damage sustained in maturity. Following bilateral lesions of posterior middle suprasylvian sulcal (pMSs) cortex in the cat, deficits were identified in both visual orienting and landmark discrimination tasks. However, the deficits on the visual orienting task were only profound for the first few days following the lesion and orienting abilities returned to normal levels within the first 2 weeks postlesion. In contrast, no such attenuation of the effect of the lesion was evident on the landmark discrimination task. Following recovery of function on the visual orienting task, individual cortical areas flanking the lesion were bilaterally deactivated with cooling. Reversible deactivation of anterior middle suprasylvian sulcal (aMSs) cortex, but none of the other adjacent cortices, yielded visual orienting deficits that are not found in intact animals during deactivation of aMSs cortex. Therefore, we concluded that the visual orienting functions normally mediated by pMSs cortex were able to relocate to aMSs cortex following lesion of pMSs cortex. Finally, bilateral lesion of both pMSs and aMSs cortices yielded visual orienting deficits that did not attenuate. Overall, this series of experiments demonstrates that certain visual functions may relocate to specific cortical loci following damage to discrete areas within posterior parietal cortex.

Visual recognition and visually guided action after early bilateral lesion of occipital cortex: a behavioral study of a 4.6-year-old girl

We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It was revealed that the child had non-severely impaired basic visual abilities and ocular motility, a selective perceptual deficit of figure-ground segregation, impaired visual recognition and abnormal navigating through space. Even if the child's visual functioning was not optimal, this was the expression of adaptive anatomic and functional brain modifications that occurred following the early lesion. Anatomic brain structure was studied with anatomic MRI and Diffusor Tensor Imaging (DTI)-MRI. This behavioral study may provide an important contribution to understanding the impact of an early lesion of the visual system on the development of visual functions and on the immature brain's potential for reorganisation related to when the damage occurred.

The role of functional neuroimaging in pediatric brain injury

The aim of this article is to review empirical studies published in the last 10 years that used various functional neuroimaging techniques to assess pediatric patients with brain injury. Overall, these studies have demonstrated the ability of functional neuroimaging to offer unique information concerning the diagnosis, clinical outcome, and recovery mechanisms after pediatric brain injury. Future research using functional neuroimaging is recommended to better understand the functional reorganization and neurodevelopmental consequences resulting from brain injury. Such research might allow clinicians to design tailored early-intervention and rehabilitation programs to maximize the recovery process for pediatric patients. Limitations and advantages associated with the use of functional neuroimaging in pediatric populations are discussed.

Visual recovery after perinatal stroke evidenced by functional and diffusion MRI: case report

BACKGROUND

After perinatal brain injury, clinico-anatomic correlations of functional deficits and brain plasticity remain difficult to evaluate clinically in the young infant. Thus, new non-invasive methods capable of early functional diagnosis are needed in young infants.

CASE PRESENTATION

The visual system recovery in an infant with perinatal stroke is assessed by combining diffusion tensor imaging (DTI) and event-related functional MRI (ER-fMRI). All experiments were done at 1.5T. A first DTI experiment was performed at 12 months of age. At 20 months of age, a second DTI experiment was performed and combined with an ER-fMRI experiment with visual stimuli (2 Hz visual flash). At 20 months of age, ER-fMRI showed significant negative activation in the visual cortex of the injured left hemisphere that was not previously observed in the same infant. DTI maps suggest recovery of the optic radiation in the vicinity of the lesion. Optic radiations in the injured hemisphere are more prominent in DTI at 20 months of age than in DTI at 12 months of age.

CONCLUSION

Our data indicate that functional cortical recovery is supported by structural modifications that concern major pathways of the visual system. These neuroimaging findings might contribute to elaborate a pertinent strategy in terms of diagnosis and rehabilitation.

Neuroplasticity after unilateral visual cortex damage in the newborn cat

Anatomical, electrophysiological, and behavioral studies implicate extrastriate cortex as a major contributor to the sparing of visually guided behaviors following lesions of primary visual cortex incurred early in life. Here we report considerable sparing of the ability to detect and localize stimuli in the hemifield contralateral to unilateral early lesions of all contiguous visually-responsive primary and extrastriate cortical regions (occipital, visuoparietal, and visuotemporal cortices). In the adult cat this same lesion induces a dense blindness and cats are unable to orient to any visual stimulus introduced into the contralesional hemifield. In the absence of cortical circuits, the neural sparing identified following the neonatal lesion is based on the superior colliculus and it occurs despite massive retrograde transynaptic degeneration of large numbers of retinal ganglion cells.

Greater sparing of visually guided orienting behavior after early unilateral occipital lesions: insights from a comparison with the impact of bilateral lesions

We know that cats with bilateral lesions of occipital visual cortical areas 17, 18 and 19 sustained during the first postnatal week exhibit a modest level of sparing of the ability to re-orient head and eyes to new stimuli relative to cats that incurred equivalent lesions in adulthood. We now report that cats with equivalent unilateral lesions sustained during the first postnatal week (P1-4), or at the end of the first postnatal month (P27-30), orient to stimuli presented in the contralesional field as proficiently as to stimuli introduced into the ipsilesional field. Moreover, levels of proficiency are indistinguishable from those exhibited by intact cats. Thus, the sparing is greater following unilateral lesions than following bilateral lesions, and the level of sparing approaches completeness. The difference between the bilateral and unilateral lesion results suggests types of pathway reorganizations that may emerge as a result of unilateral occipital lesions. We postulate that the greater sparing is based on modifications in both excitatory and inhibitory circuitry linked to the intact hemisphere, and we provide a framework for future investigations that should be relevant to the comprehension of the repercussions of early unilateral and bilateral lesions sustained by monkeys and humans, which also show more robust residual vision following early relative to later damage of occipital cortex.

Recovery from early cortical damage in rats. IX. Differential behavioral and anatomical effects of temporal cortex lesions at different ages of neural maturation

Rats were given lesions of the temporal association cortex on postnatal day 4 or 10, or in adulthood. Ninety days later they were trained on two visual tasks (visual-spatial navigation; horizontal-vertical stripes discrimination). Lesion animals were compared behaviorally and neuroanatomically to littermate sham control rats. The day 4 lesions produced a larger deficit in the navigation task than day 10 or adult lesions. There were no deficits in the discrimination task. Analysis of the brains showed that the day 4 lesions produced a smaller brain and thinner cortex than day 10 lesions. The day 10 lesions produced hypertrophy in the dendritic arborization of pyramidal cells in parietal cortex. The results are consistent with the general findings that perinatal cortical injury in rats produces more severe behavioral and morphological effects than similar lesions in the second week of life and that cortical lesions around day 10 lead to an increase in cortical synaptogenesis.

Reorganization of visual cortical maps after focal ischemic lesions

Plasticity after central lesions may result in the reorganization of cortical representations of the sensory input. Visual cortex reorganization has been extensively studied after peripheral (retinal) lesions, but focal cortical lesions have received less attention. In this study, we investigated the organization of retinotopic and orientation preference maps at different time points after a focal ischemic lesion in the primary visual cortex (V1). We induced a focal photochemical lesion in V1 of kittens and assessed, through optical imaging of intrinsic signals, the functional cortical layout immediately afterwards and at 4, 13, 33, and 40 days after lesion. We analyzed histologic sections and evaluated temporal changes of functional maps. Histological analysis showed a clear lesion at all time points, which shrank over time. Imaging results showed that the retinotopic and orientation preference maps reorganize to some extent after the lesion. Near the lesion, the cortical retinotopic representation of one degree of visual space expands over time, while at the same time the area of some orientation domains also increases. These results show that different cortical representations can reorganize after a lesion process and suggest a mechanism through which filling-in of a cortical scotoma can occur in cortically damaged patients.

Limit of spared pattern vision following lesions of the immature visual cortex

Lesions of primary visual cortex sustained early in life spare certain aspects of visual processing that can be linked to expansions of bypass pathways to extrastriate cortex. They also trigger, in an age-dependent way, partial or complete transneuronal retrograde degeneration of beta (X) retinal ganglion cells, which are implicated in visual processing under conditions of low contrast. We used two-dimensional geometric patterns whose saliency was reduced by gradually increasing levels of superimposed masking lines, and by reductions in spatial contrast. Normative data were collected from intact cats, and baseline lesion data were collected from cats with lesions sustained as young adults (postnatal day 180, P180). Experimental data were collected from cats that sustained lesions on P1-3 or P26-30. For high contrast patterns, the adult group was impaired at both acquisition (sequential progressive levels of masking) and concurrent (parallel high and low levels of masking) performance, whereas the early-lesioned groups were impaired only at concurrent performance. All lesion groups were equally impaired when contrast was reduced to modest or lower levels. These results show that sparing of masked-pattern learning is limited to the high end of the spatial contrast domain.