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“Navigating the network”: Localising the lesion with the advent of lesion network mapping

Sheppard, Jack, Wynford-Thomas, Ray and Robertson, Neil P. ORCID: 2023. “Navigating the network”: Localising the lesion with the advent of lesion network mapping. Journal of Neurology 270 (12) , pp. 6207-6209. 10.1007/s00415-023-12059-5

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“Localising the lesion” is a concept well-trodden by medical students beginning their journey in neurology and is considered an important step in developing a differential diagnosis. However, as demonstrated by the first two papers discussed this month, specific symptoms may be attributable to more than one lesion location. Furthermore, lesions occupying the same anatomical location do not always result in the same symptoms, as illustrated by paper three. Lesion network mapping, the theme linking all three papers, allows us to identify common neural pathways shared when heterogeneous lesions produce the same symptom. This may not only develop our understanding of neurophysiology and neuropathology in vivo but also provide more refined and validated neural targets for neurostimulation therapy. Whilst discussing each of the papers in this month’s journal club, we encourage you to consider whether, for assessment of some neurological diseases, we should move away from “localising the lesion” and towards “navigating the network”. This approach may facilitate a better appreciation of the brain as a series of upregulating and downregulating subcortical systems under cortical influence, that together form a carefully balanced network. As a result, when these networks are affected by pathology, symptoms often occur as the sum consequence of disruption rather than lesion location. With this may come an improved understanding of the use of deep brain stimulation (DBS), why it works, and how its application can be optimised.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Additional Information: License information from Publisher: LICENSE 1: URL:, Type: open-access
Publisher: Springer
ISSN: 0340-5354
Date of First Compliant Deposit: 9 November 2023
Date of Acceptance: 11 October 2023
Last Modified: 22 Nov 2023 14:37

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