Identification of the primary motor area by three-dimensional reconstruction of the corticospinal tract using diffusion tensor imaging

Functional MRI （fMRI） is widely used as a non-invasive method for the evaluation of pre-operation motor function.However,patients with cortical function impairment,such as those with hemiparesis,can rarely achieve hand clenching,a typical fMRI task for central sulcus identification,and the method is also of limited use in uncooperative children.Thus,it is important to develop a new method for identifying primary motor areas （PMA） in such individuals.This study used corticospinal tractography to identify the PMA in 20 patients with deep-seated brain tumor.Two regions of interest were set within the brainstem for corticospinal tract （CST） fiber tracking：one at the level of the pons and the other at the level of the cerebral peduncle.The CST fiber tracking results and fMRI activation signals were merged with three-dimensional anatomic MRI findings.The consistency of identifying the PMA by CST and fMRI was analyzed.fMRI activation signals were distributed mainly in the contralateral central sulcus around the omega-shaped hand knob.The CST consistently propagated from the pons and cerebral peduncle to the suspected PMA location.There was a good correlation between CST fiber tracking results and fMRI activation signals in terms of their abilities to identify the PMA.The differences between fMRI and CST fiber tracking findings may result from our functional task,which consisted only of hand movements.Our results indicate that diffusion tensor imaging is a useful brain mapping technique for identifying the PMA in paralyzed patients and uncooperative children.

Plasticity of motor function and surgical outcomes in patients with cerebral arteriovenous malformation involving primary motor area:insight from fMRI and DTI

Background:Patients who have a cerebral arteriovenous malformation (cAVMs) in the motor cortex can have displaced function. The finding and its relationship to recovery from surgery is not known. Methods:We present the five cases with cAVMs involving precentral knob and/or paracentral lobule and without preoperative motor deficits. We used motor activation areas derived from Functional functional MRI (fMRI) as a region of interesting (ROI) to launch the plasticity of cerebrospinal tracts (CST). All the results were incorporated into the neuronavigation platform for surgical treatment. Intraoperative electric cortical stimulation (ECS) was used to map motor areas. Modified Rankin Scale (mRS) of hands and feets were performed on postoperative day 2, 7 and at month 3, 6 during follow-up period. All the patients suffered from motor deficits regardless of cortical activation patterns. Results:Three patients showed functionally seeded CST in or around the AVM, and were validated by intraoperative electrical stimulation (ECS). Patient 4 had two aberrant functionally seeded fiber tracts away from the lesion, but were proved to be non-functional by postoperative motor deficits. Patient 3 with motor cortex and fiber tract within a diffuse AVMs nidus, complete paralysis of upper extremity after operation and has a persistent motor deficit during 6-month follow-up period. Conclusions:The plasticity of motor cortex on fMRI doesn’t prevent post-operative motor deficits. Functionally mapped fiber tract within or abutting AVM nidus predicts transient and persistent motor deficit.

Changes in sensorimotor regions of the cerebral cortex in congenital amusia:a case-control study

Perceiving pitch is a central function of the human auditory system;congenital amusia is a disorder of pitch perception.The underlying neural mechanisms of congenital amusia have been actively discussed.However,little attention has been paid to the changes in the motor rain within congenital amusia.In this case-control study,17 participants with congenital amusia and 14 healthy controls underwent functional magnetic resonance imaging while resting with their eyes closed.A voxel-based degree centrality method was used to identify abnormal functional network centrality by comparing degree centrality values between the congenital amusia group and the healthy control group.We found decreased degree centrality values in the right primary sensorimotor areas in participants with congenital amusia relative to controls,indicating potentially decreased centrality of the corresponding brain regions in the auditory-sensory motor feedback network.We found a significant positive correlation between the degree centrality values and the Montreal Battery of Evaluation of Amusia scores.In conclusion,our study identified novel,hitherto undiscussed candidate brain regions that may partly contribute to or be modulated by congenital amusia.Our evidence supports the view that sensorimotor coupling plays an important role in memory and musical discrimination.The study was approved by the Ethics Committee of the Second Xiangya Hospital,Central South University,China(No.WDX20180101GZ01)on February 9,2019.

Is effect of transcranial direct current stimulation on visuomotor coordination dependent on task difficulty?

Transcranial direct current stimulation （tDCS）, an emerging technique for non-invasive brain stimulation, is increasingly used to induce changes in cortical excitability and modulate motor behavior, especially for upper limbs. The purpose of this study was to investigate the effects of tDCS of the primary motor cortex on visuomotor coordination based on three levels of task difficulty in healthy subjects. Thirty-eight healthy participants underwent real tDCS or sham tDCS. Using a single-blind, sham-controlled crossover design, tDCS was applied to the primary motor cortex. For real tDCS conditions, tDCS intensity was 1 mA while stimulation was applied for 15 minutes. For the sham tDCS, electrodes were placed in the same position, but the stimu- lator was turned off after 5 seconds. Visuomotor tracking task, consisting of three levels （levels 1, 2, 3） of difficulty with higher level indicating greater difficulty, was performed before and after tDCS application. At level 2, real tDCS of the primary motor cortex improved the accurate index compared to the sham tDCS. However, at levels 1 and 3, the accurate index was not significantly increased after real tDCS compared to the sham tDCS. These findings suggest that tasks of mod- erate difficulty may improve visuomotor coordination in healthy subjects when tDCS is applied compared with easier or more difficult tasks.