Neurophysiologische und bildgebende Prädiktoren der Funktionserholung nach Schlaganfall

Zusammenfassung

Die Funktionserholung nach Schlaganfall wird zu großen Teilen von der Reorganisation zere­braler Netzwerke bestimmt. Diese Prozesse können im Menschen in-vivo mit nicht-invasiven Messverfahren dargestellt werden. Insbesondere die Magnetresonanztomografie (MRT) und die transkranielle Magnetstimulation (TMS) haben wesentlich dazu beigetragen, den Zusammenhang zwischen struktureller Läsion, kortikaler Reorganisation und funktioneller Erholung zu verstehen. In diesem Übersichtsartikel fassen wir wesentliche Befunde aus struktureller und funktioneller MRT sowie TMS-Studien hinsichtlich der Reorganisation des motorischen Systems und funktioneller Erholung zusammen. Darüber hinaus zeigen wir, wie Informationen aus MRT und TMS dazu genutzt werden können, um das Erholungspotenzial der Patienten vorherzusagen. Zukünftig könnten diese Verfahren dazu eingesetzt werden, um rehabilitative Therapie zu individualisieren und das Outcome der Patienten zu verbessern.

Abstract

Recovery of function after stroke is strongly driven by the reorganization of neural networks. These processes can be investigated in-vivo in patients by means of non-invasive brain mapping techniques. Especially approaches like magnetic resonance imaging (MRI) and transcranial magnetic stimulation (TMS) enable insights into how changes in neural networks relate to functional recovery. We here review recent structural and functional MRI as well as TMS studies on the neural mechanisms underlying motor recovery after stroke. Furthermore, we demonstrate how these techniques can be used to predict the potential for recovery in patients. In the future, the combination of MRI and TMS might help to individualize rehabilitative treatments in patients according to specific disturbances in brain structure and activity in order to improve the final outcome.

Schlüsselwörter

Schlaganfall - Reorganisation - Funktionserholung - TMS - fMRT

Key words

stroke - reorganization - recovery - TMS - fMRI

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