RESUMEN

Unlike their peripheral nervous system counterparts, the capacity of central nervous system neurons and axons for regeneration after injury is minimal. Although a myriad of therapies (and different combinations thereof) to help promote repair and recovery after spinal cord injury (SCI) have been trialed, few have progressed from bench-top to bedside. One of the few such therapies that has been successfully translated from basic science to clinical applications is electrical stimulation (ES). Although the use and study of ES in peripheral nerve growth dates back nearly a century, only recently has it started to be used in a clinical setting. Since those initial experiments and seminal publications, the application of ES to restore function and promote healing have greatly expanded. In this review, we discuss the progression and use of ES over time as it pertains to promoting axonal outgrowth and functional recovery post-SCI. In doing so, we consider four major uses for the study of ES based on the proposed or documented underlying mechanism: (1) using ES to introduce an electric field at the site of injury to promote axonal outgrowth and plasticity; (2) using spinal cord ES to activate or to increase the excitability of neuronal networks below the injury; (3) using motor cortex ES to promote corticospinal tract axonal outgrowth and plasticity; and (4) leveraging the timing of paired stimuli to produce plasticity. Finally, the use of ES in its current state in the context of human SCI studies is discussed, in addition to ongoing research and current knowledge gaps, to highlight the direction of future studies for this therapeutic modality.

Asunto(s)

RESUMEN

Verbally-mediated arithmetic fact retrieval has been suggested to be subserved by a left-lateralized network including angular gyrus and hippocampus. However, the contribution of these areas to retrieval of arithmetic facts has been under debate lately, challenging the prominent role of the angular gyrus in arithmetic fact retrieval. In the present study, we evaluated changes in structural connectivity of left hippocampus and left angular gyrus in 32 participants following a short extensive drill training of complex multiplication. We observed a significant increase of structural connectivity in fibers encompassing the left hippocampus but not the left angular gyrus. As such, our findings substantiate that the left hippocampus plays a central role in arithmetic fact retrieval. While both structures, left angular gyrus and left hippocampus seem to be parts of the network processing arithmetic facts, hippocampus actually seems to subserve encoding and retrieval of arithmetic facts. In turn, the role of the left angular gyrus might rather be to mediate the fact retrieval network as to whether or not processes of fact retrieval are referred to.

Asunto(s)

RESUMEN

BACKGROUND: Preoperative functional magnetic resonance imaging (fMRI) helps to preserve neurological function and ensure maximal tumor tissue excision. We studied the lateralization and localization of speech centers in select cases of tumors around the left (dominant) inferior frontal gyrus (IFG). METHODS: Twenty-three right-handed patients, harboring tumors involving the left (dominant) IFG or causing mass effect or edema extending onto the left IFG, were recruited over 17 months. Preoperatively, all patients underwent language and speech assessment followed by MRI and fMRI with paradigm (picture naming). Normative data for language fMRI was taken from the institute's imaging data bank. RESULTS: The study included 23 patients [mean age: 38.9 (±11.9) years; M: F = 16:7; 9 - normal speech, 14 - abnormal speech]. Group analysis of controls showed significant activation in the region of interest (ROI) - left Brodmann's areas (BAs) 44,45. Group analysis of patients with normal speech showed no activation in the left BAs 44,45; however, activation was noted in the immediate adjacent areas, left BAs 13,47 and contralateral prefrontal cortex. Group analysis of patients with impaired speech showed no activation in BAs 44,45 or in the immediate adjacent areas. CONCLUSIONS: Neuroplasticity in the brain may enable functional language areas to shift to adjoining or distant regions in the brain when the primary areas are involved by intrinsic tumors. This phenomenon is more likely in slow-growing compared to fast-growing tumors. Preoperative language fMRI may help us in identifying and protecting these areas during surgery.

RESUMEN

PURPOSE: Following limb amputation, central and peripheral nervous system relays partially maintain their functions and can be exploited for interfacing prostheses. The aim of this study is to investigate, for the first time by means of an EEG-TMS co-registration study, whether and how direct bidirectional connection between brain and hand prosthesis impacts on sensorimotor cortical topography. METHODS: Within an experimental protocol for robotic hand control, a 26 years-old, left-hand amputated male was selected to have implanted four intrafascicular electrodes (tf-LIFEs-4) in the median and ulnar nerves of the stump for 4 weeks. Before tf-LIFE-4s implant (T0) and after the training period, once electrodes have been removed (T1), experimental subject's cortico-cortical excitability, connectivity and plasticity were tested via a neuronavigated EEG-TMS experiment. RESULTS: The statistical analysis clearly demonstrated a significant modulation (with t-test p < 0.0001) of EEG activity between 30 and 100 ms post-stimulus for the stimulation of the right hemisphere. When studying individual latencies in that time range, a global amplitude modulation was found in most of the TMS-evoked potentials; particularly, the GEE analysis showed significant differences between T0 and T1 condition at 30 ms (p < 0.0404), 46 ms (p < 0.0001) and 60 ms (p < 0.007) latencies. Finally, also a clear local decrement in N46 amplitude over C4 was evident. No differences between conditions were observed for the stimulation of the left hemisphere. CONCLUSIONS: The results of this study confirm the hypothesis that bidirectional neural interface could redirect cortical areas -deprived of their original input/output functions- toward restorative neuroplasticity. This reorganization strongly involves bi-hemispheric networks and intracortical and transcortical modulation of GABAergic inhibition.

Asunto(s)

RESUMEN

There is an increasing awareness about the importance of translation from basic scientific findings into practical application for efficiently improving human health, especially in the pharmaceutical industry. In the field of neurorehabilitation, however, the bench-to-bedside process continues to be developing, and thus most of the therapeutic interventions have encountered barriers during exploration of evidence-based effectiveness. Despite this immaturity, constraint-induced movement therapy (CIT), a well-evidenced treatment evolved from research in nonhuman primates, is suggested to be an ideal paradigm of translational research in the field of neurorehabilitation. This article reviews the evolvement of CIT with regards to its behavioral efficacy and neuroimaging evidence through the translation roadmap developed by the National Institutes of Health. We also discuss prospects for the application of combined interventions, such as stem cell therapy or pharmaceutical prescription, with appropriate screening of patients beforehand, as well as an efficient delivery mode after the treatment. To achieve such goals and consolidate evidenced-based neurorehabilitation, we provide a framework for applications into the translational research of other therapeutic interventions aside from CIT.