Plasticité des aires motrices corticales: Progrès récents et perspectives thérapeutiques

In the past decade, there have been considerable advances in understanding the neuronal bases of sensory and motor map reorganisation in adults and it is now clear that cortical representations are not invariant and stable, but rather, are dynamic and can continuously be modified. In human subjects, substantial advances in this field have been possible because of the spectacular development of non-invasive imaging and brain stimulation techniques. This review addresses specific questions about the capacity of motor maps in adult primates, including man, to change in response to behaviourally relevant experiences or as a result of central or peripheral lesion. The first part of this review deals with recent progress in understanding the role of the primary motor codex (M1) in both motor control and cognition. The organisation and function of multiple "non-primary" motor areas located rostrally to the primary motor cortex and in the cingulate cortex are also discussed. This review then focuses on advances made in understanding motor cortex plasticity in different conditions. Firstly, since representations in M1 have been shown to change after motor learning, the contribution of M1 in motor learning has been insinuated; arguments against and in favour of this view are discussed. In addition, data suggesting that intracortical circuitry of M1 may play a role in map reorganisation following motor learning are also evaluated. Secondly, a large body of evidence from both animal and human observations is reviewed that confirms that M1 representations can also be altered as a result of changes in availability of effectors or following sensory deprivation. The mechanisms underlying such a plasticity of cortical maps following peripheral lesions are increasingly well understood. Thirdly, we discuss data showing that a corticospinal system lesion can lead to a complete reorganisation of the area allocated to the hand representation in the primary motor codex or to a reorganization of the whole network of motor areas responsible for voluntary movements. As a conclusion, therapeutical perspectives that result from a better understanding of those various mechanisms responsible for motor map plasticity are briefly discussed.