Cerebral imaging of post-stroke plasticity and tissue repair
Revue Neurologique. 2017-11-01; 173(9): 577-583
DOI: 10.1016/j.neurol.2017.09.007
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Loubinoux I(1), Brihmat N(2), Castel-Lacanal E(2), Marque P(2).
Author information:
(1)Inserm/UPS, UMR1214, Université de Toulouse, Toulouse NeuroImaging Center,
ToNIC, Pavillon Baudot, CHU Purpan, place du Docteur-Baylac, 31024 Toulouse
cedex 3, France. Electronic address: .
(2)Inserm/UPS, UMR1214, Université de Toulouse, Toulouse NeuroImaging Center,
ToNIC, Pavillon Baudot, CHU Purpan, place du Docteur-Baylac, 31024 Toulouse
cedex 3, France.
Six months after stroke onset, 50 % of patients are still disabled and
dependent, while many brain mechanisms of recovery remain partially unknown or
misunderstood. However, brain imaging and cerebral connectivity analytical
techniques have provided invaluable insights into such mechanisms and identified
two main patterns of brain reorganization depending on stroke severity. The
contralesional primary motor cortex can take over motor function in severely
impaired patients, whereas the ipsilesional motor cortex or hemisphere
reorganize themselves in good recoverers. These patterns evolve with time after
stroke, and highlight ipsilesional and contralesional primary and secondary
areas that appear to take over lost functions. The crucial role of these areas
has been confirmed by histological tracer studies. In addition, non-invasive
techniques can stimulate post-stroke brain plasticity, although appropriate
targets first need to be found. Imaging has proved useful for finding such
appropriate targets and has also provided biomarkers of efficacy with various
therapies. Moreover, it has provided some clues to the mechanisms of action of
recovery-enhancing drugs. These imaging techniques have also identified patients
who show atypical reorganization and recovery patterns. Thus, it may be
necessary to design individualized and targeted therapies.
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