1
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Gurdiel-Álvarez F, Navarro-López V, Varela-Rodríguez S, Juárez-Vela R, Cobos-Rincón A, Sánchez-González JL. Transcranial magnetic stimulation therapy for central post-stroke pain: systematic review and meta-analysis. Front Neurosci 2024; 18:1345128. [PMID: 38419662 PMCID: PMC10899389 DOI: 10.3389/fnins.2024.1345128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. It has been reported that repetitive transcranial magnetic stimulation (rTMS) may be effective in these cases of pain. Aim The aim of this study was to investigate the efficacy of rTMS in patients with central post-stroke pain (CPSP). Methods We included randomized controlled trials or Controlled Trials published until October 3rd, 2022, which studied the effect of rTMS compared to placebo in CPSP. We included studies of adult patients (>18 years) with a clinical diagnosis of stroke, in which the intervention consisted of the application of rTMS to treat CSP. Results Nine studies were included in the qualitative analysis; 6 studies (4 RCT and 2 non-RCT), with 180 participants, were included in the quantitative analysis. A significant reduction in CPSP was found in favor of rTMS compared with sham, with a large effect size (SMD: -1.45; 95% CI: -1.87; -1.03; p < 0.001; I2: 58%). Conclusion The findings of the present systematic review with meta-analysis suggest that there is low quality evidence for the effectiveness of rTMS in reducing CPSP. Systematic review registration Identifier (CRD42022365655).
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Affiliation(s)
- Francisco Gurdiel-Álvarez
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - Sergio Varela-Rodríguez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Raúl Juárez-Vela
- Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain
| | - Ana Cobos-Rincón
- Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain
| | - Juan Luis Sánchez-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
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2
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Qi Y, Xu Y, Wang H, Wang Q, Li M, Han B, Liu H. Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke. Cent Nerv Syst Agents Med Chem 2024; 24:117-128. [PMID: 38299298 DOI: 10.2174/0118715249277597231226064144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024]
Abstract
Stroke continues to be the main cause of motor disability worldwide. While rehabilitation has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.
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Affiliation(s)
- Yuan Qi
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Yujie Xu
- Chengde Medical College Affiliated Hospital, Chengde, Hebei, CN, China
| | - Huailu Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Qiujia Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Meijie Li
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Bo Han
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Haijie Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
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3
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Tavazzi E, Bergsland N, Pirastru A, Cazzoli M, Blasi V, Baglio F. MRI markers of functional connectivity and tissue microstructure in stroke-related motor rehabilitation: A systematic review. Neuroimage Clin 2021; 33:102931. [PMID: 34995869 PMCID: PMC8741615 DOI: 10.1016/j.nicl.2021.102931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stroke-related disability is a major problem at individual and socio-economic levels. Neuromotor rehabilitation has a key role for its dual action on affected body segment and brain reorganization. Despite its known efficacy in clinical practice, the extent and type of effect at a brain level, mediated by neuroplasticity, are still under question. OBJECTIVE To analyze studies applying MRI markers of functional and structural connectivity in patients affected with stroke undergoing motor rehabilitation, and to evaluate the effect of rehabilitation on brain reorganization. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were applied to select studies applying quantitative non-conventional MRI techniques on patients undergoing motor rehabilitation, both physical and virtual (virtual reality, mental imagery). Literature search was conducted using MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE from inception to 30th June 2020. RESULTS Forty-one out of 6983 papers were included in the current review. Selected studies are heterogeneous in terms of patient characteristics as well as type, duration and frequency of rehabilitative approach. Neuromotor rehabilitation promotes neuroplasticity, favoring functional recovery of the ipsilesional hemisphere and activation of anatomically and functionally related brain areas in both hemispheres, to compensate for damaged tissue. CONCLUSIONS The evidence derived from the analyzed studies supports the positive impact of rehabilitation on brain reorganization, despite the high data heterogeneity. Advanced MRI techniques provide reliable markers of structural and functional connectivity that may potentially aid in helping to implement the most appropriate rehabilitation intervention.
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Affiliation(s)
- E Tavazzi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - N Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.
| | - A Pirastru
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M Cazzoli
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - V Blasi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - F Baglio
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
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4
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Storch S, Samantzis M, Balbi M. Driving Oscillatory Dynamics: Neuromodulation for Recovery After Stroke. Front Syst Neurosci 2021; 15:712664. [PMID: 34366801 PMCID: PMC8339272 DOI: 10.3389/fnsys.2021.712664] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022] Open
Abstract
Stroke is a leading cause of death and disability worldwide, with limited treatments being available. However, advances in optic methods in neuroscience are providing new insights into the damaged brain and potential avenues for recovery. Direct brain stimulation has revealed close associations between mental states and neuroprotective processes in health and disease, and activity-dependent calcium indicators are being used to decode brain dynamics to understand the mechanisms underlying these associations. Evoked neural oscillations have recently shown the ability to restore and maintain intrinsic homeostatic processes in the brain and could be rapidly deployed during emergency care or shortly after admission into the clinic, making them a promising, non-invasive therapeutic option. We present an overview of the most relevant descriptions of brain injury after stroke, with a focus on disruptions to neural oscillations. We discuss the optical technologies that are currently used and lay out a roadmap for future studies needed to inform the next generation of strategies to promote functional recovery after stroke.
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Affiliation(s)
- Sven Storch
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Montana Samantzis
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Matilde Balbi
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
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5
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Gao H, Sun M, Li M, Wang C, Yu C, Wang Y, Xu K. Force Decoding of Caudal Forelimb Area and Rostral Forelimb Area in Chronic Stroke Rats. IEEE Trans Biomed Eng 2021; 68:3078-3086. [PMID: 33661731 DOI: 10.1109/tbme.2021.3063903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Brain machine interfaces (BMIs) used for movement restoration primarily rely on studies of motor decoding. It has been proved that local field potentials (LFPs) from primary motor cortex and premotor cortex of normal rodents could be used for decoding motor signals. However, few studies have explored the decoding performance of these brain areas under motor cortex damage. In this work, we focus on force decoding performance of LFPs spectrum from both ipsilesional caudal forelimb area (CFA) and rostral forelimb area (RFA) of rodents with ischemia over CFA. After three months of ischemia induced by photothrombosis over CFA, the power of high-frequency bands (>120 Hz) from both CFA and RFA can decode force signals by Kalman filters. The fair performance of CFA indicates motor reorganization over penumbra. Further exploration of RFA decoding ability proves that at least four electrodes of RFA should be used on decoding and electrodes far from CFA of stroke rats could achieve almost as good results as those close to CFA of normal rats, which indicates the motor remapping. Experimental results show the long-term stability of PM LFPs decoding performance of stroke rats as the trained Kalman model could be used to accurately decode force some days later which provides a possibility for online decoding system. In conclusion, our work shows that even under CFA ischemia, high-frequency power of LFPs from RFA is still able to accurately decode force signals and has long stability, which provides the possibility of BMIs for motor function reconstruction of chronic stroke patients.
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6
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Aswendt M, Pallast N, Wieters F, Baues M, Hoehn M, Fink GR. Lesion Size- and Location-Dependent Recruitment of Contralesional Thalamus and Motor Cortex Facilitates Recovery after Stroke in Mice. Transl Stroke Res 2020; 12:87-97. [PMID: 32166716 PMCID: PMC7803721 DOI: 10.1007/s12975-020-00802-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023]
Abstract
Brain lesions caused by cerebral ischemia or hemorrhage lead to a local breakdown of energy homeostasis followed by irreversible cell death and long-term impairment. Importantly, local brain lesions also generate remote functional and structural disturbances, which contribute to the behavioral deficit but also impact the recovery of function. While spontaneous recovery has been associated with endogenous repair mechanisms at the vascular, neural, and immune cell levels, the impact of structural plasticity on sensory-motor dysfunction and recovery thereof remains to be elucidated by longitudinal imaging in a mouse model. Here, we applied behavioral assessments, in vivo fiber tracking, and histological validation in a photothrombotic stroke mouse model. Atlas-based whole-brain structural connectivity analysis and ex vivo histology revealed secondary neurodegeneration in the ipsilesional brain areas, mostly in the dorsal sensorimotor area of the thalamus. Furthermore, we describe for the first time a lesion size-dependent increase in structural connectivity between the contralesional primary motor cortex and thalamus with the ipsilesional cortex. The involvement of the contralesional hemisphere was associated with improved functional recovery relative to lesion size. This study highlights the importance of in vivo fiber tracking and the role of the contralesional hemisphere during spontaneous functional improvement as a potential novel stroke biomarker and therapeutic targets.
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Affiliation(s)
- Markus Aswendt
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany. .,Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany.
| | - Niklas Pallast
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Frederique Wieters
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Mayan Baues
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Mathias Hoehn
- Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany.,Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany.,Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
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7
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Boddington LJ, Gray JP, Schulz JM, Reynolds JNJ. Low-intensity contralesional electrical theta burst stimulation modulates ipsilesional excitability and enhances stroke recovery. Exp Neurol 2019; 323:113071. [PMID: 31669070 DOI: 10.1016/j.expneurol.2019.113071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 12/25/2022]
Abstract
Targeting interhemispheric inhibition using brain stimulation has shown potential for enhancing stroke recovery. Following stroke, increased inhibition originating from the contralesional hemisphere impairs motor activation in ipsilesional areas. We have previously reported that low-intensity electrical theta burst stimulation (TBS) applied to an implanted electrode in the contralesional rat motor cortex reduces interhemispheric inhibition, and improves functional recovery when commenced three days after cortical injury. Here we apply this approach at more clinically relevant later time points and measure recovery from photothrombotic stroke, following three weeks of low-intensity intermittent TBS (iTBS), continuous TBS (cTBS) or sham stimulation applied to the contralesional motor cortex. Interhemispheric inhibition and cellular excitability were measured in the same rats from single pyramidal neurons in the peri-infarct area, using in vivo intracellular recording. A minimal dose of iTBS did not enhance motor function when applied beginning one month after stroke. However both a high and a low dose of iTBS improved recovery to a similar degree when applied 10 days after stroke, with the degree of recovery positively correlated with ipsilesional excitability. The final level of interhemispheric inhibition was negatively correlated with excitability, but did not independently correlate with functional recovery. In contrast, contralesional cTBS left recovery unaltered, but decreased ipsilesional excitability. These data support focal contralesional iTBS and not cTBS as an intervention for enhancing stroke recovery and suggest that there is a complex relationship between functional recovery and interhemispheric inhibition, with both independently associated with ipsilesional excitability.
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Affiliation(s)
- Laura J Boddington
- Department of Anatomy and the Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin 9054, New Zealand
| | - Jason P Gray
- Department of Anatomy and the Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin 9054, New Zealand
| | - Jan M Schulz
- Department of Biomedicine, University of Basel, Basel 4056, Switzerland
| | - John N J Reynolds
- Department of Anatomy and the Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin 9054, New Zealand.
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8
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Pasquini M, Lai S, Spalletti C, Cracchiolo M, Conti S, Panarese A, Caleo M, Micera S. A Robotic System for Adaptive Training and Function Assessment of Forelimb Retraction in Mice. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1803-1812. [PMID: 30106680 DOI: 10.1109/tnsre.2018.2864279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rodent models are decisive for translational research in healthy and pathological conditions of motor function thanks to specific similarities with humans. Here, we present an upgraded version of the M-Platform, a robotic device previously designed to train mice during forelimb retraction tasks. This new version significantly extends its possibilities for murine experiments during motor tasks: 1) an actuation system for friction adjustment allows to automatically adapt pulling difficulty; 2) the device can be used both for training, with a retraction task, and for assessment, with an isometric task; and 3) the platform can be integrated with a neurophysiology systems to record simultaneous cortical neural activity. Results of the validation experiments with healthy mice confirmed that the M-Platform permits precise adjustments of friction during the task, thus allowing to change its difficulty and that these variations induce a different improvement in motor performance, after specific training sessions. Moreover, simultaneous and high quality (high signal-to-noise ratio) neural signals can be recorded from the rostral forelimb area (RFA) during task execution. With the novel features presented herein, the M-Platform may allow to investigate the outcome of a customized motor rehabilitation protocol after neural injury, to analyze task-related signals from brain regions interested by neuroplastic events and to perform optogenetic silencing or stimulation during experiments in transgenic mice.
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9
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Spalletti C, Alia C, Lai S, Panarese A, Conti S, Micera S, Caleo M. Combining robotic training and inactivation of the healthy hemisphere restores pre-stroke motor patterns in mice. eLife 2017; 6:28662. [PMID: 29280732 PMCID: PMC5762156 DOI: 10.7554/elife.28662] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
Focal cortical stroke often leads to persistent motor deficits, prompting the need for more effective interventions. The efficacy of rehabilitation can be increased by ‘plasticity-stimulating’ treatments that enhance experience-dependent modifications in spared areas. Transcallosal pathways represent a promising therapeutic target, but their role in post-stroke recovery remains controversial. Here, we demonstrate that the contralesional cortex exerts an enhanced interhemispheric inhibition over the perilesional tissue after focal cortical stroke in mouse forelimb motor cortex. Accordingly, we designed a rehabilitation protocol combining intensive, repeatable exercises on a robotic platform with reversible inactivation of the contralesional cortex. This treatment promoted recovery in general motor tests and in manual dexterity with remarkable restoration of pre-lesion movement patterns, evaluated by kinematic analysis. Recovery was accompanied by a reduction of transcallosal inhibition and ‘plasticity brakes’ over the perilesional tissue. Our data support the use of combinatorial clinical therapies exploiting robotic devices and modulation of interhemispheric connectivity.
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Affiliation(s)
| | - Claudia Alia
- CNR Neuroscience Institute, Pisa, Italy.,Scuola Normale Superiore, Pisa, Italy
| | - Stefano Lai
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy
| | - Alessandro Panarese
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy
| | - Sara Conti
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy
| | - Silvestro Micera
- Scuola Superiore Sant'Anna, Translational Neural Engineering Area, The BioRobotics Institute, Pontedera, Italy.,Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, Ecole Polytechnique Federale de Lausanne (EPFL), Center for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland
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10
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Vannini E, Caleo M, Chillemi S, Di Garbo A. Dynamical properties of LFPs from mice with unilateral injection of TeNT. Biosystems 2017; 161:57-66. [PMID: 28918300 DOI: 10.1016/j.biosystems.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 01/08/2023]
Abstract
Local field potential (LFP) recordings were performed from the visual cortex (V1) of a focal epilepsy mouse model. Epilepsy was induced by a unilateral injection of the synaptic blocker tetanus neurotoxin (TeNT). LFP signals were simultaneously recorded from V1 of both hemispheres of each animal under acute and chronic conditions (i.e. during and after the period of TeNT action). All data were analysed by using nonlinear time series methods. Suitable values of the lag time and embedding dimension for phase space reconstruction were estimated by employing well-known methods. The results showed that lag times are sensitive to the presence of TeNT. Interestingly, TeNT promoted an increase in the level of linear and nonlinear correlation of LFP signals. The values of the embedding dimension failed to show any dependence on the presence of the neurotoxin. However, a local nonlinear prediction method showed that the presence of TeNT increases the predictability, quantified by the normalized prediction error, of the neural recordings. From a neurophysiological point of view, the above results suggest that TeNT injected in one hemisphere strongly impacts the local electrical activity of the neural populations in the opposite hemisphere. We hypothesize that this could arise from a qualitative and quantitative alteration of the transmission properties of the callosal fibers.
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Affiliation(s)
- Eleonora Vannini
- Neuroscience Institute, CNR-National Research Council, 56124 Pisa, Italy
| | - Matteo Caleo
- Neuroscience Institute, CNR-National Research Council, 56124 Pisa, Italy
| | - Santi Chillemi
- Institute of Biophysics, CNR-National Research Council, 56124 Pisa, Italy
| | - Angelo Di Garbo
- Institute of Biophysics, CNR-National Research Council, 56124 Pisa, Italy.
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11
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Alia C, Spalletti C, Lai S, Panarese A, Lamola G, Bertolucci F, Vallone F, Di Garbo A, Chisari C, Micera S, Caleo M. Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation. Front Cell Neurosci 2017; 11:76. [PMID: 28360842 PMCID: PMC5352696 DOI: 10.3389/fncel.2017.00076] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/03/2017] [Indexed: 12/21/2022] Open
Abstract
Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration.
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Affiliation(s)
- Claudia Alia
- CNR Neuroscience Institute, National Research Council (CNR)Pisa, Italy; Laboratory of Biology, Scuola Normale SuperiorePisa, Italy
| | | | - Stefano Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna Pontedera, Italy
| | - Alessandro Panarese
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna Pontedera, Italy
| | - Giuseppe Lamola
- Department of Neuroscience, Unit of Neurorehabilitation-University Hospital of Pisa Pisa, Italy
| | - Federica Bertolucci
- Department of Neuroscience, Unit of Neurorehabilitation-University Hospital of Pisa Pisa, Italy
| | - Fabio Vallone
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'AnnaPontedera, Italy; CNR Biophysics Institute, National Research Council (CNR)Pisa, Italy; Neural Computation Laboratory, Center for Neuroscience and Cognitive Systems @UniTn, Italian institute of Technology (IIT)Rovereto, Italy
| | - Angelo Di Garbo
- CNR Biophysics Institute, National Research Council (CNR) Pisa, Italy
| | - Carmelo Chisari
- Department of Neuroscience, Unit of Neurorehabilitation-University Hospital of Pisa Pisa, Italy
| | - Silvestro Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'AnnaPontedera, Italy; Ecole Polytechnique Federale de Lausanne (EPFL), Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, Center for Neuroprosthetics and Institute of BioengineeringLausanne, Switzerland
| | - Matteo Caleo
- CNR Neuroscience Institute, National Research Council (CNR) Pisa, Italy
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12
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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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13
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Vallone F, Vannini E, Cintio A, Caleo M, Di Garbo A. Time evolution of interhemispheric coupling in a model of focal neocortical epilepsy in mice. Phys Rev E 2016; 94:032409. [PMID: 27739854 DOI: 10.1103/physreve.94.032409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Indexed: 11/07/2022]
Abstract
Epilepsy is characterized by substantial network rearrangements leading to spontaneous seizures and little is known on how an epileptogenic focus impacts on neural activity in the contralateral hemisphere. Here, we used a model of unilateral epilepsy induced by injection of the synaptic blocker tetanus neurotoxin (TeNT) in the mouse primary visual cortex (V1). Local field potential (LFP) signals were simultaneously recorded from both hemispheres of each mouse in acute phase (peak of toxin action) and chronic condition (completion of TeNT effects). To characterize the neural electrical activities the corresponding LFP signals were analyzed with several methods of time series analysis. For the epileptic mice, the spectral analysis showed that TeNT determines a power redistribution among the different neurophysiological bands in both acute and chronic phases. Using linear and nonlinear interdependence measures in both time and frequency domains, it was found in the acute phase that TeNT injection promotes a reduction of the interhemispheric coupling for high frequencies (12-30 Hz) and small time lag (<20 ms), whereas an increase of the coupling is present for low frequencies (0.5-4 Hz) and long time lag (>40 ms). On the other hand, the chronic period is characterized by a partial or complete recovery of the interhemispheric interdependence level. Granger causality test and symbolic transfer entropy indicate a greater driving influence of the TeNT-injected side on activity in the contralateral hemisphere in the chronic phase. Lastly, based on experimental observations, we built a computational model of LFPs to investigate the role of the ipsilateral inhibition and exicitatory interhemispheric connections in the dampening of the interhemispheric coupling. The time evolution of the interhemispheric coupling in such a relevant model of epilepsy has been addressed here.
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Affiliation(s)
- F Vallone
- Institute of Biophysics, CNR-National Research Council, 56124 Pisa, Italy.,The Biorobotics Institute, Scuola Superiore Sant'Anna, 56026 Pisa, Italy
| | - E Vannini
- Neuroscience Institute, CNR-National Research Council, 56124 Pisa, Italy
| | - A Cintio
- Institute of Biophysics, CNR-National Research Council, 56124 Pisa, Italy
| | - M Caleo
- Neuroscience Institute, CNR-National Research Council, 56124 Pisa, Italy
| | - A Di Garbo
- Institute of Biophysics, CNR-National Research Council, 56124 Pisa, Italy.,INFN-Section of Pisa, 56127 Pisa, Italy
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