Revised version; submitted to the Journal of Anatomy. Special Edition: Development of the Neocortex (connected to the Symposium of the British Anatomical Society).
Reorganization after pre- and perinatal brain lesions*
Article first published online: 8 SEP 2010
© 2010 The Author. Journal of Anatomy © 2010 Anatomical Society of Great Britain and Ireland
Journal of Anatomy
Volume 217, Issue 4, pages 469–474, October 2010
How to Cite
Staudt, M. (2010), Reorganization after pre- and perinatal brain lesions. Journal of Anatomy, 217: 469–474. doi: 10.1111/j.1469-7580.2010.01262.x
- Issue published online: 8 SEP 2010
- Article first published online: 8 SEP 2010
- Accepted for publication 3 June 2010 Article published online 23 July 2010
- cerebral palsy;
- early brain lesions;
The developing human brain can compensate for pre- and perinatally acquired focal lesions more effectively than the adult brain. The mechanisms by which this effective reorganization is achieved vary considerably between different functional systems, reflecting differences in the normal maturation of these systems. In the motor system, descending cortico-spinal motor projections have already reached their spinal target zones at the beginning of the third trimester of pregnancy, with initially bilateral projections from each hemisphere. During normal development, the ipsilateral projections are gradually withdrawn, whereas the contralateral projections persist. When, during this period, a unilateral brain lesion disrupts the cortico-spinal projections of one hemisphere, the ipsilateral projections from the contralesional hemisphere will persist. This allows the contralesional hemisphere to take over motor control over the paretic extremities. Although this mechanism of reorganization is available throughout the pre- and perinatal period, the efficacy of this ipsilateral takeover of motor functions decreases with increasing age at the time of the insult. In the somatosensory system, ascending thalamo-cortical somatosensory projections have not yet reached their cortical target zones at the beginning of the third trimester of pregnancy. Therefore, these projections can still ‘react’ to brain lesions acquired during this period, and can form ‘axonal bypasses’ around periventricular white matter lesions to reach their original cortical target areas in the postcentral gyrus. Thus, somatosensory functions can be well preserved even in cases of large periventricular lesions. In contrast, when the postcentral gyrus itself is affected, no signs for reorganization have been observed. Accordingly, somatosensory functions are often poor in these patients. Language functions can be normal even in patients with extensive early left-hemispheric brain lesions. This is achieved by language organization in the right hemisphere, which takes place in brain regions homotopic to the classical left-hemispheric language areas in normal subjects. In patients with periventricular lesions, the degree of right-hemispheric takeover of language functions correlates with the severity of structural damage to facial (and, thus, articulatory) motor projections.