CNS transplants promote anatomical plasticity and recovery of function after spinal cord injury
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Abstract:
We are using neural tissue transplantation after spinal cord injury to identify the rules which determine the response of young neurons to injury, to identify the mechanisms underlying anatomical plasticity and recovery of function following spinal cord injury, and to determine the conditions which change during development, leading to the more restricted growth capacity of mature neurons following injury. Spinal cord lesions at birth interrupt different pathways at different relative stages in their development. Neural tissue transplants modify the response of the immature central nervous system neurons to injury. In the current studies, we have used neuroanatomical and behavioral methods to compare the response of the late-developing corticospinal pathway with that of brainstem-spinal pathways which are intermediate in their development and that of the relatively mature dorsal root pathway. We find that both late-developing and regenerating neuronal populations contribute to the transplant-induced anatomical plasticity, and suggest that this anatomical plasticity underlies the transplant-mediated sparing and recovery of function.Keywords:
Corticospinal tract
Spontaneous recovery
Purpose: To determine the optimal timing of rehabilitation and its role in corticospinal tract (CST) plasticity after stroke. Methods: Rats were subjected to photothrombotic infarct. The large stroke (LS) and small stroke (SS) groups were subdivided
Corticospinal tract
Cerebral peduncle
Sprouting
Stroke
Spontaneous recovery
Pyramidal tracts
Stroke Recovery
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The corticospinal tract features a largely exposed course through the brainstem, and is therefore at risk in many brainstem-related procedures. No large case series on motor-evoked potential (MEP) monitoring during brainstem surgery have been reported as yet.To understand intraoperative MEP changes during brainstem-related surgery, and to explore the value of MEP monitoring for preventing permanent new paresis.Myogenic MEPs after transcranial electrical train stimulation were monitored in 70 cases of intraparenchymal (n = 39) and extraparenchymal (n = 31) brainstem-related tumours and vascular lesions. MEP recordings failed in another five cases. Motor outcome and intraoperative MEP results were documented prospectively and correlated for this study.Significant MEP changes occurred in 46% of cases. Stable and only reversibly deteriorated MEPs warranted unimpaired motor outcome (n = 50, 71% of all cases). Irreversible deterioration and reversible loss (n = 19, 27%) indicated a 37% risk for transient deficit. Irreversible loss (one case, 1.5%) predicted permanent paresis. MEPs and motor outcome correlated equally well in intra- and extraparenchymal lesions. Somatosensory-evoked potentials (SEPs) did not reliably reflect motor outcome. Permanent motor deficit occurred in one out five cases (20%) with failed MEP recordings.MEP monitoring-as opposed to SEPs-is a valid indicator of corticospinal function in brainstem-related surgery, independent from the type of lesion operated on. New deficit occurs only after more pronounced MEP changes than in supratentorial surgery, but complete loss as in spinal surgery is not required. MEPs may help to prevent permanent new paresis.
Corticospinal tract
Paresis
Somatosensory evoked potential
Evoked potential
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Although it is believed that little recovery occurs after adult mammalian spinal cord injury, in fact significant spontaneous functional improvement commonly occurs after spinal cord injury in humans. To investigate potential mechanisms underlying spontaneous recovery, lesions of defined components of the corticospinal motor pathway were made in adult rats in the rostral cervical spinal cord or caudal medulla. Following complete lesions of the dorsal corticospinal motor pathway, which contains more than 95% of all corticospinal axons, spontaneous sprouting from the ventral corticospinal tract occurred onto medial motoneuron pools in the cervical spinal cord; this sprouting was paralleled by functional recovery. Combined lesions of both dorsal and ventral corticospinal tract components eliminated sprouting and functional recovery. In addition, functional recovery was also abolished if dorsal corticospinal tract lesions were followed 5 weeks later by ventral corticospinal tract lesions. We found extensive spontaneous structural plasticity as a mechanism correlating with functional recovery in motor systems in the adult central nervous system. Experimental enhancement of spontaneous plasticity may be useful to promote further recovery after adult central nervous system injury.
Corticospinal tract
Spontaneous recovery
Pyramidal tracts
Sprouting
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Corticospinal tract
Pyramidal tracts
Stroke
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Corticospinal tract
Forelimb
Spontaneous recovery
Pyramidal tracts
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Corticospinal tract
Intraoperative neurophysiological monitoring
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Stuttering
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Magnetic resonance (MR) imaging as an indicator of recovery from hemiparesis was evaluated in 60 patients with spontaneous intracerebral hemorrhage. T2-weighted MR images revealed early MR abnormality (EMA) of the corticospinal tract within 1 week of ictus. Most patients without EMA recovered beyond Brunnstrom's Recovery Stage 3 while only a few patients with EMA did so. Patients with EMA cannot regain motor function because EMA is almost always followed by complete tract degeneration. EMA in the brainstem and poor motor function recovery are closely correlated.
Corticospinal tract
Abnormality
Hemiparesis
Spontaneous recovery
Stroke
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