Diaschisis: past, present, future.

Area of Science:

• Neuroscience
• Clinical Neurology
• Brain Imaging

Background:

• The concept of diaschisis, neurophysiological changes distant to a focal brain lesion, was introduced in 1914.
• Early research and imaging studies only partially confirmed its clinical significance, leading to a decline in its mainstream research.
• Recent advancements in neuroimaging have renewed interest in diaschisis, particularly in understanding brain network complexity.

Purpose of the Study:

• To explore the renewed understanding of diaschisis through modern neuroimaging techniques.
• To differentiate and highlight the clinical relevance of connectional diaschisis compared to focal diaschisis.
• To propose a future systematic approach for investigating the clinical role and therapeutic potential of diaschisis.

Main Methods:

• Utilizing advanced neuroimaging techniques to investigate structural and functional connectivity changes distant to brain lesions.
• Analyzing the impact of focal lesions on brain networks, specifically motor and attentional networks.
• Evaluating the relationship between remote connectivity changes and clinical recovery.

Main Results:

• Connectional diaschisis, defined by changes in structural and functional connectivity, demonstrates a more consistent correlation with clinical findings than focal diaschisis.
• Diaschisis in motor and attentional networks after stroke is particularly significant.
• Normalization of remote connectivity changes is associated with improved patient recovery.

Conclusions:

• Connectional diaschisis offers a more clinically relevant framework for understanding remote effects of brain lesions.
• Future research should integrate advanced imaging and electrophysiological techniques to map lesions and model diaschisis.
• Therapeutic strategies targeting remote neurophysiological changes, such as neuromodulation, hold promise for restoring function and validating the clinical significance of diaschisis.