title: Local changes in network structure contribute to late communication recovery after severe brain injury.
abstract: Spontaneous recovery of brain function after severe brain injury may evolve over a long time period and is likely to involve both structural and functional reorganization of brain networks. We longitudinally tracked the recovery of communication in a patient with severe brain injury using multimodal brain imaging techniques and quantitative behavioral assessments measured at the bedside over a period of 2 years and 9 months (21 months after initial injury). Structural diffusion tensor imaging revealed changes in brain structure across interhemispheric connections and in local brain regions that support language and visuomotor function. These findings correlated with functional brain imaging using functional magnetic resonance imaging and positron emission tomography, which demonstrated increased language network recruitment in response to natural speech stimuli, graded increases in interhemispheric interactions of language-related frontal cortices, and increased cerebral metabolic activity in the language-dominant hemisphere. In addition, electrophysiological studies showed recovery of synchronization of sleep spindling activity. The observed changes suggest a specific mechanism for late recovery of communication after severe brain injury and provide support for the potential of activity-dependent structural and functional remodeling over long time periods.
authors.affiliation: Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA. dat2011@med.cornell.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Thengone
authors.affiliation: Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA.|Citigroup Biomedical Imaging Center, Department of Radiology, Weill Cornell Medical College, New York, NY 10021, USA.
authors.forename: Henning U
authors.initials: HU
authors.lastname: Voss
authors.affiliation: Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: Esteban A
authors.initials: EA
authors.lastname: Fridman
authors.affiliation: Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10065, USA.|Department of Neurology, Weill Cornell Medical College, New York, NY 10065, USA.|Rockefeller University, New York, NY 10065, USA.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Schiff
mesh_terms: D001519:Behavior; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000737:chemistry; D006801:Humans; D007802:Language; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18