Acute inactivation of the contralesional hemisphere for longer durations improves recovery after cortical injury
With the introduction of non-invasive brain stimulation methods aimed at modulating the excitability of cortical areas after stroke, many groups are intensively investigating the effects of inhibition of the contralesional hemisphere on functional recovery. Although the reported results of these studies are very promising, limitations of enrolling acute stroke patients as well as technical difficult of establishing continuous inhibition protocols have left several open ended questions regarding the treatment parameters and patient selection. For example, the efficacy of inhibition treatment in acute setting after stroke and the effect of treatment duration are two questions that are virtually unexplored. Therefore, in the laboratory of Prof. Numa Dancause, we took advantage of a well established rodent model of cortical ischemic lesion to gain direct and objective insight about the importance of contralesional inactivation on motor recovery of the paretic limb. Using an Endothelin-1 rodent model of ischemic cortical lesion, we pharmacologically inactivated the contralesional hemisphere with a GABA agonist (Muscimol). By doing so we were interested in the effect of early treatment when contralesional inactivation is initiated rapidly after the lesion. Early after induction of cortical ischemic lesion, the contralesional hemisphere was inactivated with continuous infusion of the Muscimol for 3, 7 or 14 days in three different groups of animals. In a fourth group, Muscimol was infused at slower rate for 14 days to provide additional insights on the relation between the effects of inactivation on the non-paretic forelimb behavior and the recovery of the paretic forelimb. We included a group of animals with spontaneous recovery that received no inactivation after lesion.  Our results indicated that increasing inactivation duration (from 3 to 14 days) accelerated the recovery of grasping function. Both groups with 14 days of inactivation had similar recovery profiles and performed better than animals that spontaneously recovered. In fact, the duration of inactivation, not the intensity, correlated with the better functional outcomes.  Our results support early contralesional inactivation to improve recovery of the paretic forelimb after cortical lesion. Moreover, based on our results, the duration of inactivation is the most important factor to correlate with the functional outcomes. Therefore, by providing precise temporal and behavioral evidence, our results provide a window of opportunity for the researchers in which the current gap in our understanding of the clinical efficacy of contralesional inhibition in acute phase after stroke can be approached with more confidence.
Avant-bras Inhibition Inactivation Rat Contralesional Forelimb Cortical lesion Stroke Recovery Rodent Endothelin1 Muscimol