Effect of Transcranial Direct Current Stimulation of Motor Cortex versus Insula Cortex on Chronic Post-Mastectomy Pain: Randomized Sham-Controlled Trial

Background: Transcranial direct current stimulation (tDCS) across cortical brain areas appears to improve various forms of pain, yet evidence of tDCS efficiency and ideal stimulation target is lacking. This study aimed to compare the add-on analgesic efficacy of concentric electrode transcranial direct current stimulation (CE-tDCS) stimulation over the primary motor cortex versus the insular cortex on the management of chronic postmastectomy pain. Method: Prospective randomized double-blind sham-controlled study enrolled eighty patients with chronic postmastectomy pain that were randomly assigned to four groups: active motor (AM), sham motor (SM), active insula (AI) and sham insula (SI) group, each received 5 sessions for 20-minute duration with 2 mA tDCS over the targeted area of the contralateral side of pain. Our primary outcome was VAS score, the secondary outcomes were VDS score, LANSS score and depression symptoms by HAM-D scores, assessment was done at 4 time points (prestimulation, after 5th session, 15th day and one month after the last session). Results: Both active tDCS groups (motor and insula) showed reduction of VAS (P Conclusion: Active tDCS stimulation either targeting the primary motor cortex or the insula cortex has add-on analgesic effect for controlling neuropathic chronic post mastectomy pain and the maximum effect was at 15 days after the last session.

MOTOR CORTEX NETWORKS IN STROKE PATIENTS DURING RECOVERY WITH fMRI

To investigate changes of functional activation areas of the cerebral cortex and the connectivity of motor cortex networks （MCNs） in stroke patients during the recovery, five patients with the infarct in their left hemispheres are recruited. Functional magnetic resonance imaging （fMRI） is performed in the second, fourth, eighth, and sixteenth weeks after the stroke. Images are analyzed using the professional software SPM5 to obtain the bilateral activation of the motor cortex in left and right handgrip tests. MCN data are extracted from the active areas, and the structural and functional characteristic parameters are computed to indicate the connectivity of the network. Results show that the ipsilesional hemisphere recruits more areas with less active extent during the handgrip test, compared with the contralesional hemisphere. MCN shows a higher overall degree of statistical independence and more statistical dependence among motor areas with the gradual recovery. It can help physicians understand the recovery mechanism.

Disappearance of unaffected motor cortex activation by repetitive transcranial magnetic stimulation in a patient with cerebral infarct

The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke （Jang, 2011）. Because stroke patients who had shown recovery by this mechanism usually showed poorer motor function, compared with patients who showed recovery by other mechanisms, several researchers have considered this mechanism as a maladaptive plasticity （]ang, 2013）.

Neuronal injury in the motor cortex after chronic stroke and lower limb motor impairment: a voxelbased lesion symptom mapping study

Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro- nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deficits expected after damage to the cortical motor system due to stroke. These findings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

Correlation between primary motor cortex neural activity and fingertip force following transcranial magnetic stimulation

A better understanding of the neural mechanisms of finger-force regulation can help to explain the relationship between the central nervous system and nerve-muscle force, as well as assist in motor functional rehabilitation and the development robot hand designs. In the present study, 11 healthy volunteers performed a different target force-tracking task, which involved the index finger alone, index and middle finger together, and the combination of four fingers （i.e., index, middle, ring, and little）. The target force trace corresponded to 3 levels of 20% maximal voluntary changes （MVC）, 30% MVC, and 40% MVC in 20 seconds. In the test, an unexpected single 120% motor threshold transcranial magnetic stimulation was applied to the primary motor cortex （M1） during force tracking. Results revealed that peak force changes increased with increasing background force and the number of involved task fingers. These results demonstrate that M1 neural activities correlate with finger-force production, and M1 plays a role in finger-force control. Moreover, different neuronal networks were required for different finger patterns; a complicated task required multi-finger combinations and a complicated neuronal network comprised a large number of neurons.

Optogenetics stimulates nerve reorganization in the contralesional anterolateral primary motor cortex in a mouse model of ischemic stroke

The anterolateral motor cortex of rodents is an important motor auxiliary area,and its function is similar to that of the premotor area in humans.Activation and inhibition of the contralesional anterolateral motor cortex(cALM)have been shown to have direct effects on motor behavior.However,the significance of cALM activation and inhibition in the treatment of stroke remains unclear.This study investigated the role of optogenetic cALM stimulation in a mouse model of cerebral stroke.The results showed that 21-day optogenetic cALM inhibition,but not activation,improved neurological function.In addition,optogenetic cALM stimulation substantially altered dendritic structural reorganization and dendritic spine plasticity,as optogenetic cALM inhibition resulted in increased dendritic length,number of dendritic spines,and number of perforated synapses,whereas optogenetic activation led to an increase in the number of multiple synapse boutons and the number of dendritic intersections.Furthermore,RNA-seq analysis showed that multiple biological processes regulated by the cALM were upregulated immediately after optogenetic cALM inhibition,and that several immediate-early genes(including cFOS,Erg1,and Sema3f)were expressed at higher levels after optogenetic inhibition than after optogenetic activation.These results were confirmed by quantitative reverse transcription-polymerase chain reaction.Finally,immunofluorescence analysis showed that the c-FOS signal in layer V of the primary motor cortex in the ischemic hemisphere was higher after optogenetic cALM activation than it was after optogenetic cALM inhibition.Taken together,these findings suggest that optogenetic cALM stimulation promotes neural reorganization in the primary motor cortex of the ischemic hemisphere,and that optogenetic cALM inhibition and activation have different effects on neural plasticity.The study was approved by the Experimental Animal Ethics Committee of Fudan University(approval No.201802173 S)on March 3,2018.

Enhanced motor cortex excitability after spinal cord injury

Transcranial magnetic stimulation（TMS）represents a useful non-invasive approach to studying cortical physiology,in addition to the descending motor pathways（Hallett,2000）,and may also be used to investigate the intracortical facilitatory and inhibitory mechanisms.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

Experimental Research PARTICIPATION OF GABA IN SH EMANATING DESCENDING MODULATION ON THE NUCLEUS CENTRUM MEDIANUM VIA MOTOR CORTEX IN ACUPUNCTURE ANALGESIA

The effects of electrical stimulation of second somatosensory area(S Ⅱ)andelectroacupuncture(EA)at Huantiao(GB 30)and Yanglinquan(GB 34)points on nociceptive re-sponses of neurons in the nucleus centrum medianum(CM)in the thalamus were respectively ob-served after topical application of bicuculline(Bic)at the motor cortex(MCtx),and the results werecompared with those obtained in the saline control group.It was found that following application ofBic either electrical stimulation of SII(n=11)or EA(n=11)yielded obvious inhibition on nocicep-tive responses of CM neurons(P【0.05),which was similar to the inhibitory effects obtained in thesaline control groups(n=11,n=10).After GABA application at MCtx electrical stimulation of SIIfailed to show inhibition on nociceptive responses in 3 CM neurons.It is indicated that GABA in MC-tx is involved in SII originating corticofugal regulation of nucleus CM in acupuncture analgesia.

Investigating connectional characteristics of Motor Cortex network

To understand the connectivity of cerebral cor-tex, especially the spatial and temporal pattern of movement, functional magnetic resonance imaging (fMRI) during subjects performing finger key presses was used to extract functional networks and then investigated their character-istics. Motor cortex networks were constructed with activation areas obtained with statistical analysis as vertexes and correlation coefficients of fMRI time series as linking strength. The equivalent non-motor cortex networks were constructed with certain distance rules. The graphic and dynamical measures of motor cor-tex networks and non-motor cortex networks were calculated, which shows the motor cortex networks are more compact, having higher sta-tistical independence and integration than the non-motor cortex networks. It indicates the motor cortex networks are more appropriate for information diffusion.

The Primary Motor Cortex Stimulation Attenuates Cold Allodynia in a Chronic Peripheral Neuropathic Pain Condition in <i>Rattus norvegicus</i>

Background: The primary motor cortex (M1) stimulation (MCS) is a useful tool for attenuation of the peripheral neuropathic pain in patients with pharmacologically refractory pain. Furthermore, that neurological procedure may also cause antinociception in rodents with neuropathic pain. Cold allodynia is a frequent clinical finding in patients with neuropathic pain, then, we evaluated if an adapted model of neuropathy induced by chronic constriction injury (CCI) of the ischiadicus nervus (sciatic nerve) produces cold allodynia in an animal model of chronic pain. In addition, we also investigated the effect of the electrical stimulation of the M1 on chronic neuropathic pain condition in laboratory animals. Methods: Male Wistar rats were used. An adapted model of peripheral mononeuropathy induced by CCI was carried out by placing a single loose ligature around the right sciatic nerve. The acetone test was used to evaluate the cold allodynia in CCI or Sham (without ligature) rats. The MCS (M1) was performed at low-frequency (20 μA, 100 Hz) during 15 s by deep brain stimulation (DBS-Thomas Recording device) 21 days after CCI or Sham procedures. The cold allodynia was measured before and immediately after the neurostimulation of M1 in the following time-window: 0, 15 and 30 min after MCS. Results: Cold allodynia threshold increased in animals with chronic neuropathic pain submitted to the acetone test 21 days after the CCI surgery. The M1-stimulation by DBS procedure decreased the cold allodynia immediately and until 30 min after M1-stimulation in rats with chronic neuropathic pain. Conclusion: The current proposal for a CCI model by a single loose ligature of the sciatic nerve can be employed as an experimental model of chronic neuropathic pain in rats submitted to peripheral nervous system injury. The M1-stimulation produced antinociception in rats with chronic neuropathic pain. Thus, we reinforced that the MCS decreases cold allodynia in laboratory animals submitted to persistent sciatic nerve constriction and can be a more reasonable procedure for the treatment of chronic intractable neuropathic pain.

The Secondary Motor Cortex-striatum Circuit Contributes to Suppressing Inappropriate Responses in Perceptual Decision Behavior

The secondary motor cortex(M2)encodes choice-related information and plays an important role in cue-guided actions.M2 neurons innervate the dorsal striatum(DS),which also contributes to decision-making behavior,yet how M2 modulates signals in the DS to influence perceptual decision-making is unclear.Using mice performing a visual Go/No-Go task,we showed that inactivating M2 projections to the DS impaired performance by increasing the false alarm(FA)rate to the reward-irrelevant No-Go stimulus.The choice signal of M2 neurons correlated with behavioral performance,and the inactivation of M2 neurons projecting to the DS reduced the choice signal in the DS.By measuring and manipulating the responses of direct or indirect pathway striatal neurons defined by M2 inputs,we found that the indirect pathway neurons exhibited a shorter response latency to the No-Go stimulus,and inactivating their early responses increased the FA rate.These results demonstrate that the M2-to-DS pathway is crucial for suppressing inappropriate responses in perceptual decision behavior.

Regulation of specific abnormal calcium signals in the hippocampal CA1 and primary cortex M1 alleviates the progression of temporal lobe epilepsy

Temporal lobe epilepsy is a multifactorial neurological dysfunction syndrome that is refractory,resistant to antiepileptic drugs,and has a high recurrence rate.The pathogenesis of temporal lobe epilepsy is complex and is not fully understood.Intracellular calcium dynamics have been implicated in temporal lobe epilepsy.However,the effect of fluctuating calcium activity in CA1 pyramidal neurons on temporal lobe epilepsy is unknown,and no longitudinal studies have investigated calcium activity in pyramidal neurons in the hippocampal CA1 and primary motor cortex M1 of freely moving mice.In this study,we used a multichannel fiber photometry system to continuously record calcium signals in CA1 and M1 during the temporal lobe epilepsy process.We found that calcium signals varied according to the grade of temporal lobe epilepsy episodes.In particular,cortical spreading depression,which has recently been frequently used to represent the continuously and substantially increased calcium signals,was found to correspond to complex and severe behavioral characteristics of temporal lobe epilepsy ranging from gradeⅡto gradeⅤ.However,vigorous calcium oscillations and highly synchronized calcium signals in CA1 and M1 were strongly related to convulsive motor seizures.Chemogenetic inhibition of pyramidal neurons in CA1 significantly attenuated the amplitudes of the calcium signals corresponding to gradeⅠepisodes.In addition,the latency of cortical spreading depression was prolonged,and the above-mentioned abnormal calcium signals in CA1 and M1 were also significantly reduced.Intriguingly,it was possible to rescue the altered intracellular calcium dynamics.Via simultaneous analysis of calcium signals and epileptic behaviors,we found that the progression of temporal lobe epilepsy was alleviated when specific calcium signals were reduced,and that the end-point behaviors of temporal lobe epilepsy were improved.Our results indicate that the calcium dynamic between CA1 and M1 may reflect specific epileptic behaviors corresponding to different grades.Furthermore,the selective regulation of abnormal calcium signals in CA1 pyramidal neurons appears to effectively alleviate temporal lobe epilepsy,thereby providing a potential molecular mechanism for a new temporal lobe epilepsy diagnosis and treatment strategy.

From cortex to cord: motor circuit plasticity after spinal cord injury

Spinal cord injury is associated with chronic sensorimotor deficits due to the interruption of ascending and descending tracts between the brain and spinal cord. Functional recovery after anatomically complete spinal cord injury is limited due to the lack of long-distance axonal regeneration of severed fibers in the adult central nervous system. Most spinal cord injuries in humans, however, are anatomically incomplete. Although restorative treatment options for spinal cord injury remain currently limited, research from experimental models of spinal cord injury have revealed a tremendous capability for both spontaneous and treatment-induced plasticity of the corticospinal system that supports functional recovery. We review recent advances in the understanding of corticospinal circuit plasticity after spinal cord injury and concentrate mainly on the hindlimb motor cortex, its corticospinal projections, and the role of spinal mechanisms that support locomotor recovery. First, we discuss plasticity that occurs at the level of motor cortex and the reorganization of cortical movement representations. Next, we explore downstream plasticity in corticospinal projections. We then review the role of spinal mechanisms in locomotor recovery. We conclude with a perspective on harnessing neuroplasticity with therapeutic interventions to promote functional recovery.

Neurons in Primary Motor Cortex Encode Hand Orientation in a Reach-to-Grasp Task

It is disputed whether those neurons in the primary motor cortex（M1） that encode hand orientation constitute an independent channel for orientation control in reach-to-grasp behaviors. Here, we trained two monkeys to reach forward and grasp objects positioned in the frontal plane at different orientation angles, and simultaneously recorded the activity of M1 neurons. Among the 2235 neurons recorded in M1, we found that 18.7% had a high correlation exclusively with hand orientation, 15.9% with movement direction, and 29.5% with both movement direction and hand orientation. The distributions of neurons encoding hand orientation and those encoding movement direction were not uniform but coexisted in the same region. The trajectory of hand rotation was reproduced by the firing patterns of the orientation-related neurons independent of the hand reaching direction. These resultssuggest that hand orientation is an independent component for the control of reaching and grasping activity.

Dyskinesia is Closely Associated with Synchronization of Theta Oscillatory Activity Between the Substantia Nigra Pars Reticulata and Motor Cortex in the Off L-dopa State in Rats

Excessive theta(θ)frequency oscillation and synchronization in the basal ganglia(BG)has been reported in elderly parkinsonian patients and animal models of levodopa(L-dopa)-induced dyskinesia(LID),particularly theθoscillation recorded during periods when L-dopa is withdrawn(the off L-dopa state).To gain insight into processes underlying this activity,we explored the relationship between primary motor cortex(M1)oscillatory activity and BG output in LID.We recorded local field potentials in the substantia nigra pars reticulata(SNr)and M1 of awake,inattentive resting rats before and after L-dopa priming in Sham control,Parkinson disease model,and LID model groups.We found that chronic L-dopa increasedθsynchronization and information flow between the SNr and M1 in off L-dopa state LID rats,with a SNr-to-M1 flow directionality.Compared with the on state,θoscillational activity(θsynchronization and informationflow)during the off state were more closely associated with abnormal involuntary movements.Our findings indicate thatθoscillation in M1 may be consequent to abnormal synchronous discharges in the BG and support the notion that M1θoscillation may participate in the induction of dyskinesia.

Modulation of Beta Oscillations for Implicit Motor Timing in Primate Sensorimotor Cortex during Movement Preparation

Motor timing is an important part of sensorimotor control. Previous studies have shown that beta oscillations embody the process of temporal perception in explicit timing tasks. In contrast, studies focusing on beta oscillations in implicit timing tasks are lacking. In this study, we set up an implicit motor timing task and found a modulation pattern of beta oscillations with temporal perception during movement preparation. We trained two macaques in a repetitive visually-guided reach-to-grasp task with different holding intervals. Spikes and local field potentials were recorded from microelectrode arrays in the primary motor cortex, primary somatosensory cortex, and posterior parietal cortex. We analyzed the association between beta oscillations and temporal interval in fixedduration experiments(500 ms as the Short Group and1500 ms as the Long Group) and random-duration experiments(500 ms to 1500 ms). The results showed that the peak beta frequencies in both experiments ranged from15 Hz to 25 Hz. The beta power was higher during the hold period than the movement(reach and grasp) period.Further, in the fixed-duration experiments, the mean poweras well as the maximum rate of change of beta power in the first 300 ms were higher in the Short Group than in the Long Group when aligned with the Center Hit event. In contrast, in the random-duration experiments, the corresponding values showed no statistical differences among groups. The peak latency of beta power was shorter in the Short Group than in the Long Group in the fixed-duration experiments, while no consistent modulation pattern was found in the random-duration experiments. These results indicate that beta oscillations can modulate with temporal interval in their power mode. The synchronization period of beta power could reflect the cognitive set maintaining working memory of the temporal structure and attention.

Effects of Electroacupuncture on Metabolic Changes in Motor Cortex and Striatum of 6-Hydroxydopamine-Induced Parkinsonian Rats

Objective:To explore the possible underlying mechanism by investigating the effect of electroacupuncture(EA)treatment on the primary motor cortex and striatum in a unilateral 6-hydroxydopamine(6-0HDA)induced rat Parkinson's disease(PD)model.Methods:Male Sprague-Dawley rats were randomly divided into sham group(n=16),model group(n=14),and EA group(n=14).EA stimulation at Dazhui(GV 14)and Baihui(GV20)was applied to PD rats in the EA group for 4 weeks.Behavioral tests were conducted to evaluate the effectiveness of EA treatment.Metabolites were detected by 7.0 T proton nuclear magnetic resonance.Results:Following 4 weeks of EA treatment in PD model rats,the abnormal behavioral impairment induced by 6-0HDA was alleviated.In monitoring changes in metabolic activity,ratios of myoinositol/creatine(Cr)and N-acetyl aspartate(NAA)/Cr in the primary motor cortex were significantly lower at the injected side than the non-injected side in PD rats(P=0.024 and 0.020).The ratios of glutamate+glutamine(Glx)/Cr and NAA/Cr in the striatum were higher and lower,respectively,at the injected side than the non-injected side(P=0.046 and 0.008).EA treatment restored the balance of metabolic activity in the primary motor cortex and striatum.In addition,the taurine/Cr ratio and GIx/Cr ratio were elevated in the striatum of PD model rats compared to sham-lesioned rats(P=0.026 and 0.000).EA treatment alleviated the excessive glutamatergic transmission by down-regulating the striatal Glx/Cr ratio(P=0.001).The Glx/Cr ratio was negatively correlated with floor plane spontaneous locomotion in PD rats(P=0.027 and P=0.0007).Conclusions:EA treatment is able to normalize the metabolic balance in the primary motor cortex and striatum of PD rats,which may contribute to its therapeutic effect on motor deficits.The striatal GIx/Cr ratio may serve as a potential indicator of PD and a therapeutic target of EA treatment.

Long-term results of a simultaneous trial of deep brain and motor cortex stimulation in refractory neuropathic pain

Objective: Although deep brain stimulation(DBS) and motor cortex stimulation(MCS)are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods: To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis(Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results: Of the 11 patients implanted with both DBS and MCS electrodes, nine(81.8%)had successful trials. Seven of these nine patients(77.8%) responded to MCS, and two(18.2%) responded to Vc DBS. With long-term follow-up(56 ± 27.5 months), the mean numerical rating scale decreased significantly(P < 0.05). The degree of percentage pain relief in the chronic MCS(n = 7) and chronic DBS(n = 2) groups were 34.1% ± 18.2%and 37.5%, respectively, and there was no significant difference(P = 0.807). Five out of the seven MCS patients(71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions: With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Decoding grasp movement from monkey premotor cortex for real-time prosthetic hand control

Brain machine interfaces (BMIs) have demonstrated lots of successful arm-related reach decoding in past decades, which provide a new hope for restoring the lost motor functions for the disabled. On the other hand, the more sophisticated hand grasp movement, which is more fundamental and crucial for daily life, was less referred. Current state of arts has specified some grasp related brain areas and offline decoding results; however, online decoding grasp movement and real-time neuroprosthetic control have not been systematically investigated. In this study, we obtained neural data from the dorsal premotor cortex (PMd) when monkey reaching and grasping one of four differently shaped objects following visual cues. The four grasp gesture types with an additional resting state were classified asynchronously using a fuzzy k-nearest neighbor model, and an artificial hand was controlled online using a shared control strategy. The results showed that most of the neurons in PMd are tuned by reach and grasp movement, us- ing which we get a high average offline decoding accuracy of 97.1%. In the online demonstration, the instantaneous status of monkey grasping could be extracted successfully to control the artificial hand, with an event-wise accuracy of 85.1%. Overall, our results inspect the neural firing along the time course of grasp and for the first time enables asynchronous neural control of a prosthetic hand, which underline a feasible hand neural prosthesis in BMIs.