Figure 1.

Toward a dynamic and multilevel model of glioma-induced plasticity.

The dynamic dimension of the model is represented by a temporal framework (from left to right) along which different variables reflect the evolution of the disease (upper part, tumor volume in orange, white matter tract infiltration in green) and the resulting functional compensation in the same individual (lower part, global cognitive functioning in blue, and metaplastic index in purple). The multilevel dimension of the model includes at different time points of the temporal framework (here illustrated at first surgery and second surgery): (1) spatial reallocations, as attested by serial intraoperative functional mapping with direct electrostimulation, (2) a network remodeling of the functional connectome, and (3) a context-sensitive reconfiguration of the meta-network. The metaplastic index refers to the disruption of the natural course of plasticity redeployments, defined as modulations of previous plasticity learning rules (i.e., meta-plasticity) induced by milestone biological or therapeutic events (e.g., tumor birth, rehabilitation, surgery, modification of the glioma behavior). Created with Inkscape software (Inkscape.org, version 1.1.1). DES: Direct electrical stimulation.