Cortical Plasticity Following Nerve Transfer in the Upper Extremity - 22/08/11

Doi : 10.1016/j.hcl.2008.04.005

Dimitri J. Anastakis, MD, MHPE, MHCM, FRCSC, FACS ^a,^⁎ , Martijn J.A. Malessy, MD ^b, Robert Chen, MBBChir, MSc, FRCPC ^c, Karen D. Davis, PhD ^d,^e, David Mikulis, MD ^f
^a Division of Plastic Surgery, University of Toronto, 399 Bathurst Street, East Wing –2, Toronto, Ontario Canada M5G 2S8
^b Department of Neurosurgery, Leiden University Medical Centre, J-11-R-84, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
^c Division of Neurology, University of Toronto, 399 Bathurst Street, MP 13-304, Toronto, Ontario, Canada M5G 2S8
^d Division of Neurosurgery, Institute of Medical Science, University of Toronto, 399 Bathurst Street, MP14-306, Toronto, Ontario, Canada M5T 2S8
^e Division of Brain, Imaging and Behaviour – Systems Neuroscience, Toronto Western Research Institute, University Health Network, 399 Bathurst Street, MP14-306, Toronto, Ontario, Canada M5T 2S8
^f Department of Medical Imaging, University of Toronto, 399 Bathurst Street, MC 3-431, Toronto, Ontario, Canada M5G 2S8

Corresponding author.

Abstract

With increasing clinical experience, peripheral nerve surgeons have come to appreciate the important role that cortical plasticity and motor relearning play in functional recovery following a nerve transfer. Neurostimulation (transcranial magnetic stimulation), and neuroimaging (functional MRI, structural MRI, magnetoencephalography) measure different aspects of cortical physiology and when used together are powerful tools in the study of cortical plasticity. The mechanisms of cortical plasticity, according to current and widely accepted opinions, involve the unmasking of previously ineffective connections or the sprouting of intact afferents from adjacent cortical or subcortical territories. Although significant strides have been made in our understanding of cortical plasticity following nerve transfer and during motor relearning, a great deal remains that we do not understand. Cortical plasticity and its manipulation may one day become important contributors to improve functional outcome following nerve transfer.

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