Aurora Semerano, MD
European Stroke Organisation-World Stroke Organization 2020 Virtual Conference
November 7-9, 2020
The Controversies sessions during the ESO-WSO 2020 Conference are intriguing live Q&A sessions focused on grey zones in stroke care, with stroke experts defending their points of view and facing each other in interesting rounds of discussion. On the second day of the conference, the session addressed the following topics about recovery and brain repair after stroke.
Brain Repair is the Right Target to Improve Outcome — John Krakauer (United States of America)
Basing on primate experimental stroke, Dr. Krakauer showed that a certain rate of spontaneous recovery exists after stroke; however, training helps to amplify, rescue, and maintain spontaneous recovery. The main question remains: How does it happen? According to Dr. Krakauer, training-induced recovery in monkeys is not driven by cortical reorganization. Conversely, brain repair occurs via training-induced strengthening of pre-existing alternative cortico-subcortical connections. The recipe for brain repair after stroke is traced: an integrated interaction between behavior, residual architecture, and plasticity.
Brain Repair Does Not Work, Reorganisation is Key — Belen R. Ballester (Spain)
Dr. Ballester dismantled in 15 minutes three common pessimistic beliefs about recovery after stroke. Behavior drives functional and structural reorganization and can meaningfully interact with spontaneous recovery. For this purpose, high repetitive task-oriented and task-specific training is needed. Possibilities for recovery extend well beyond the classical time window of 3-6 month, and plasticity by means of structural and connectivity changes is still present beyond 1 year after stroke. Finally, it is not an invariable destiny of stroke patients to deteriorate in the chronic phase; learning and training can prevent deterioration.