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首页> 外文期刊>Neurosurgical focus >Neuroplasticity and the brain connectome: what can Jean Talairach’s reflections bring to modern psychosurgery?
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Neuroplasticity and the brain connectome: what can Jean Talairach’s reflections bring to modern psychosurgery?

机译：神经可塑性和大脑连接体：让·塔莱拉赫的思考能为现代心理外科带来什么？

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Contrary to common psychosurgical practice in the 1950s, Dr. Jean Talairach had the intuition, based on clinical experience, that the brain connectome and neuroplasticity had a role to play in psychosurgery. Due to the remarkable progress of pharmacology at that time and to the technical limits of neurosurgery, these concepts were not put into practice. Currently, these concepts are being confirmed by modern techniques such as neuroimaging and computational neurosciences, and could pave the way for therapeutic innovation in psychiatry. Psychosurgery commonly uses a localizationist approach, based on the idea that a lesion to a specific area is responsible for a deficit opposite to its function. To psychosurgeons such as Walter Freeman, who performed extensive lesions causing apparently inevitable deficit, Talairach answered with clinical data: complex psychic functions cannot be described that simply, because the same lesion does not provoke the same deficit in different patients. Moreover, cognitive impairment did not always follow efficacious psychosurgery. Talairach suggested that selectively destructing part of a network could open the door to a new organization, and that early psychotherapy could encourage this psychoplasticity. Talairach did not have the opportunity to put these concepts into practice in psychiatric diseases because of the sudden availability of neuroleptics, but connectomics and neuroplasticity gave rise to major advances in intraparenchymal neurosurgery, from epilepsy to low-grade glioma. In psychiatry, alongside long-standing theories implicating focal lesions and diffuse pathological processes, neuroimaging techniques are currently being developed. In mentally healthy individuals, combining diffusion tensor imaging with functional MRI, magnetoencephalography, and electroencephalography allows the determination of a comprehensive map of neural connections in the brain on many spatial scales, the so-called connectome. Ultimately, global neurocomputational models could predict physiological activity, behavior, and subjective feeling, and describe neuropsychiatric disorders. Connectomic studies comparing psychiatric patients with controls have already confirmed the early intuitions of Talairach. As a striking example, massive dysconnectivity has been found in schizophrenia, leading some authors to propose a “dysconnection hypothesis.” Alterations of the connectome have also been demonstrated in obsessive-compulsive disorder and depression. Furthermore, normalization of the functional dysconnectivity has been observed following clinical improvement in several therapeutic interventions, from psychotherapy to pharmacological treatments. Provided that mental disorders result from abnormal structural or functional wiring, targeted psychosurgery would require that one be able: 1) to identify the pathological network involved in a given patient; 2) to use neurostimulation to safely create a reversible and durable alteration, mimicking a lesion, in a network compatible with neuroplasticity; and 3) to predict which functional lesion would result in adapted neuronal plasticity and/or to guide neuronal plasticity to promote recovery. All these conditions, already suggested by Talairach, could now be achievable considering modern biomarkers and surgical progress.
机译：与1950年代的常规心理外科实践相反，让·塔莱拉赫（Jean Talairach）博士根据临床经验得出的直觉是，脑连接套和神经可塑性在心理外科中起着作用。由于当时药理学的显着进步以及神经外科技术的局限性，这些概念尚未付诸实践。目前，这些概念已被现代技术（例如神经影像学和计算神经科学）所证实，并可能为精神病学的治疗创新铺平道路。心理外科通常使用局部化的方法，基于这样的想法，即特定区域的病变是造成与其功能相反的缺陷的原因。对于像沃尔特·弗里曼（Walter Freeman）这样的心理医生来说，他们造成了明显的损害而造成了不可避免的赤字，塔莱拉赫（Talairach）回答了临床数据：不能简单地描述复杂的心理功能，因为同一病灶在不同患者中不会引起相同的赤字。此外，认知障碍并不总是遵循有效的心理手术。 Talairach建议选择性破坏网络的一部分可以为新组织打开大门，并且早期的心理治疗可以鼓励这种心理可塑性。由于神经安定剂的突然出现，Talairach没有机会将这些概念应用于精神疾病，但是结缔组织学和神经可塑性在实质性神经外科领域取得了重大进展，从癫痫病到低度神经胶质瘤。在精神病学中，除了涉及局灶性病变和弥漫性病理过程的长期理论之外，目前正在开发神经影像技术。在精神健康的个体中，将扩散张量成像与功能性MRI，磁脑图和脑电图相结合可以确定大脑在许多空间尺度上的神经连接的综合图，即所谓的连接组。最终，全局神经计算模型可以预测生理活动，行为和主观感觉，并描述神经精神疾病。将精神病患者与对照组进行比较的Connectomic研究已经证实了Talairach的早期直觉。作为一个明显的例子，在精神分裂症中发现了严重的不连通性，导致一些作者提出了“不连通性假说”。强迫症和抑郁症也证明了连接组的改变。此外，在从心理治疗到药物治疗的几种治疗性干预措施的临床改进后，已观察到功能障碍性连接的正常化。如果精神障碍是由异常的结构或功能连接引起的，有针对性的心理手术将要求人们能够：1）识别特定患者所涉及的病理网络; 2）在与神经可塑性兼容的网络中，使用神经刺激安全地产生可逆和持久的改变，模仿病变; 3）预测哪个功能性病变会导致适应性神经元可塑性和/或引导神经元可塑性促进恢复。考虑到现代生物标志物和外科手术的进展，Talairach已经提出的所有这些条件现在可以实现。

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