Induktion und Verstärkung von kortiko-kortikaler Reorganisation nach Schlaganfall

Zusammenfassung

Bei einem Schlaganfall kommt es zu einer akuten Hirnschädigung, welche mit einer Schädigung neuronaler Netzwerke einhergeht. Entscheidend für die Erholung nach Schlaganfall ist eine adaptive Reorganisation der überlebenden zerebralen Netzwerke durch Mechanismen neuronaler Plastizität. So kommt es zu strukturellen Veränderungen des peri-läsionellen Hirngewebes und weitreichenden zerebralen Netzwerken, wodurch der Verlust motorischer, sensibler und kognitiver Fähigkeiten funktionell kompensiert werden kann. Ergebnisse aus der neurowissenschaftlichen Grundlagenforschung zeigen, dass der kortikalen Reorganisation nach einem Schlaganfall auf zellulärer Ebene vor allem eine aktivitätsabhängige Neuvernetzung und synaptische Plastizität zugrunde liegen. Mittels funktioneller Bildgebung und elektrophysiologischer Methoden lässt sich die kortikale Reorganisation nach Schlaganfall heutzutage auch beim Menschen in vivo darstellen. Zudem stehen mit der transkraniellen direkten Stromstimulation (engl. transcranial direct current stimulation, tDCS) und der transkraniellen Magnetstimulation (engl. transcranial magnetic stimulation, TMS) nicht-invasive Hirnstimula­tionsverfahren zur Verfügung, welche es erlauben, direkt mit Mechanismen synaptischer Plastizität zu interferieren. Die Integration des in den letzten Jahren gewonnenen Wissens über die komplexen und dynamischen zerebralen Prozesse, welche einer Erholung nach einem Schlaganfall zugrunde liegen, und interventionellen Ansätzen wie nicht-invasiven Hirnstimulationsverfahren eröffnet die Möglichkeit, eine adaptive Reorganisation des Gehirns nach Schlaganfall individuell zu verstärken und damit die Erholung zu begünstigen. Dieser Artikel gibt eine Übersicht von den neurobiologischen Grundlagen der Erholung nach Schlaganfall bis hin zu ersten vielversprechenden klinischen Studien zur Verstärkung der kortikalen Reorganisation beim Menschen.

Abstract

Stroke leads to a sudden brain injury with damage in neuronal networks. Fundamental for recovery of function after stroke is an adaptive reorganization of surviving cerebral networks by mechanisms of neural plasticity. These include structural remodeling of peri-lesional brain tissue and reorganization of large-scale brain networks, thereby compensating for the structural damage and regaining lost sensation, motion and cogni­tion. Results from basic neuroscience suggest that cortical reorganization after stroke is based on activity-dependent rewiring and synaptic plasticity. Functional neuroimaging and electrophysiological techniques have allowed the investigation of cortical reorganization after stroke also in humans in vivo. In addition, non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) can directly interfere with mechanisms of synaptic plasticity. Thus, integrating knowledge gained in recent years about the complex and dynamic cerebral processes underlying recovery of function after stroke with interventional approaches using non-invasive brain stimulation can open the opportunity to individually facilitate adaptive cortical reorganization and, thereby, promote recovery. This article reviews key findings from the neural mechanisms of recovery of function after stroke to the first promising clinical studies promoting cortical reorganization in humans.

Schlüsselwörter

Netzwerk - Nicht-invasive Hirn­stimulation - Rehabilitation - Plastizität

Key words

network - non-invasive brain ­stimulation - rehabilitation - plasticity

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