MAR 13, 2019 2:20 PM PDT

Clinical Updates: Inducing Cortical Plasticity by Brain Stimulation and Prehabilitation

Presented at: Neuroscience 2019
C.E. Credits: P.A.C.E. CE Florida CE
  • Professor and Head, Department of Neurosurgery, Hospital Clinico San Carlos and Universidad Complutense de Madrid
      Board certified in Neurosurgery since 1992, he received his MD in 1987 and PhD in 1996. He has been Associate professor of Neurosurgery at the University of Valencia; Head of Clinical Division, Service of Neurosurgery at the Hospital General Univeristario de Valencia; Head of the laboratory of Neural Regeneration and Neural Repair of the Centro de Investigación Príncipe Felipe in Valencia, and Scientific Director of the Research Foundation at the Hospital General Universitario de Valencia. He received his doctorate from the University of Valencia and completed his residency in neurosurgery at the Hospital Clinico Universitario de Valencia, extending studies of functional neurosurgery at the Karolinska Hospital in Stockholm, Sweden, and of epilepsy surgery at the Montreal Neurological Institute in Canada. From the clinical point of view, he has developed programs in surgery in Parkinson's disease, epilepsy surgery, pain surgery, psychiatric surgery, radiosurgery, neuro-oncology, neuronavigation and neuroendoscopy and bioethics and quality of life in neurosurgical patients.

      His research has focused on new indications in stereotactic radiosurgery, the search for surgical treatments for drug-resistant neurological diseases, particularly in intracerebral infusion of anticonvulsant drugs, neurostimulation and cell therapy applied to neurological diseases.

      His research projects include the regeneration of the nigrostriatal pathway with biomaterials in Parkinson disease models, the use of biomaterials for the repair of the cerebral cortex, the definition of targets for deep brain stimulation using brain connectomics and the induction of brain plasticity. He has been project leader of several international and national competitive funds and he is currentnly leading six clinical trials on brain stimulation and stem cells for stroke. He has supervised 15 doctoral theses and has published more than 100 research papers in clinical and applied neurosciences. He has served as chairman of the research committee of the EANS and is member of the boards of the ESSFN and WSSFN.


    Plasticity in the brain is very extensive due to the brain’s parallel architecture and synaptic reorganization capabilities.   Because neuronal populations are typically in stable low energy minimums, it is limited under normal circumstances. This can be challenged, however, under extreme conditions. Brain stimulation is one such example.  By inhibiting active areas while rehabilitating others, electrical stimulation induces state changes in the neuronal networks.

    With the objective to achieve more aggressive resection of brain tumors affecting eloquent areas, we subjected a group of 5 patients to prehabilitation.  This was achieved by progressively inhibiting cortical activity with high frequency stimulation via implanted subdural electrodes while the patients performed intensive exercise of affected functions over an average of 30 days. Functional MR showed the reorganization of cortical activity away from the stimulated area, with adjacent or even contralateral areas activated instead of the original ones. This allowed us to perform a more extended resection of the tumors without compromising the eloquent functions.

    This procedure can be applied to additional pathologies affecting eloquent areas as well, such as epileptic foci or arteriovenous malformations. Importantly, the concept of associating cortical stimulation with rehabilitation has next level applications, for example to the recovery of lost functions after brain injury. The possibility to enhance weakened neuronal activity has been shown by pairing cortical stimulation with external physical rehabilitation with brain-machine interfaces in patients with motor deficit due to stroke. Possibilities of enhancement of plasticity by cortical stimulation are wide, although they may be limited by the existing neural networks supported by the white matter interconnections.

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