The role of mirror neurons in neurosurgical patients: A few general considerations and rehabilitation perspectives

BACKGROUND: A great deal of research has focused on demonstrating the existence of mirror neurons in humans and the factors that modulate their activity after their discovery in macaques approximately two decades ago. OBJECTIVES: With this in mind, the parieto-frontal mirror neuron system (MNS) has been described as a brain network that is activated when either an action is executed or as it is observed. The clinical importance of these findings have been related with neurological and psychiatric disorders, but no one has focused until now on the possibilities that this network could provide to achieve better results in neurosurgical patients. METHODS AND RESULTS: One of the applications of the MNS with clinical significance is the observation based rehabilitation programs. These programs have demonstrated their usefulness in certain pathologic entities but as yet there are no reports regarding neurosurgical patients in the literature. The activation of brain areas during observation of motor actions which are also activated when those actions are executed define the physiopathological principle of this kind of therapy that has been shown to get better results than standard rehabilitation programs and that should also be tested on neurosurgical patients. If observation based rehabilitation is considered, the MNS should be as intact as possible. Indeed, the surgeon can try to respect mirror areas during surgery by mapping them pre-surgically. Furthermore, damage to the MNS is associated with some degree of cognitive impairment, so better functional results can be achieved by respecting these mirror areas. CONCLUSION: Therefore, the aim of the present work is to describe how the MNS can contribute to neurosurgery and to put forward the hypothesis that by considering and using MNS properties better functional outcomes can be achieved.