Persisting neurones switch
to a ‘survivor’ phenotype and the expression of
hundreds of genes
8,9 is changed to compensate for the loss or
diminution of target-derived neurotrophic factors,
10 and in
order to regrow their axons across the site of the injury and
back into the periphery. Proximal changes, such as synaptic
reorganisation in the cortex
11–13 and spinal cord, occur
upstream of axotomised first-order motor and sensory neurones,
and may influence the functional outcome months or even years
later.
14–16 Distal to the injury, a series of molecular and cellular events,
some simultaneous, others consecutive, and collectively called
Wallerian degeneration, is triggered throughout the distal nerve
stump and within a small reactive zone at the tip of the proximal
stump (Fig. 2
![Go](http://web.jbjs.org.uk/icons/fig-up.gif)
).
17–19
http://web.jbjs.org.uk/cgi/content/full/87-B/10/1309