Brain motor system function after chronic, complete spinal cord injury

Cramer, Steven C.; Lastra, Lindsey; Lacourse, Michael G.; Cohen, Michael J.

doi:10.1093/brain/awh648

Cited by 198 publications

(184 citation statements)

References 59 publications

(72 reference statements)

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“…Whether these results hold for brain damaged patients with a full loss of motor control remains to be tested. Promising evidence comes from patients suffering from complete spinal cord injury who despite their chronic state still demonstrate motor system activation in response to attempted overt movement (Cramer et al, 2005;Hotz-Boendermaker et al, 2008).…”

Section: Motor Executionmentioning

confidence: 99%

Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients

et al. 2012

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Section: Motor Executionmentioning

confidence: 99%

Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients

et al. 2012

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“…This dynamic compensatory mechanism likely represents an adaptive remodeling response designed to preserve neurological function. Although the majority of functional neuroimaging studies have demonstrated this neuroplasticity in cerebral pathological conditions, the results of recent laboratory investigations have demonstrated that cortical reorganization can occur in response to injury to ascending and descending fiber tracts within the spinal cord 4,7,11,[19][20][21][22][23] .In this article we describe a novel method of assessing cortical representational maps for hand and foot activity in patients with CSM by using fMR imaging. In the pilot study described, we investigated the cortical plasticity in patients with CSM as a result of chronic spinal cord injury, as well as subsequent reorganization following decompression surgery.…”

mentioning

confidence: 98%

Cortical reorganization in patients with cervical spondylotic myelopathy

Holly¹,

Dong²,

Albistegui-Dubois³

et al. 2007

Journal of Neurosurgery: Spine

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Object-Recent investigations have demonstrated that the cerebral cortex can reorganize as a result of spinal cord injury and may play a role in preserving neurological function. Reorganization of cortical representational maps in patients with cervical spondylotic myelopathy (CSM) has not been previously described. The authors sought to determine the feasibility of using functional magnetic resonance (fMR) imaging in patients with CSM to investigate changes in the cortical representation of the wrist and ankle before and after surgical intervention.Methods-Four patients with clinical and imaging evidence of CSM were prospectively enrolled in this study. The patients underwent preoperative neurological examination, functional assessment, cervical imaging, and brain fMR imaging. The fMR imaging activation task undertaken was either wrist extension or ankle dorsiflexion, depending on whether the patient's primary impairment was hand dysfunction or gait difficulty. The cohort then underwent further evaluations at 6 weeks and 3 and 6 months postoperatively. In addition, five healthy volunteers underwent fMR imaging at two different time points and served as controls.In the healthy volunteers fMR imaging demonstrated areas of focal cortical activation limited to the contralateral primary motor area for the assigned motor tasks; the activation patterns were stable throughout repeated imaging. In comparison, in patients with CSM fMR imaging demonstrated expansion of the cortical representation of the affected extremity. Surgical decompression resulted in improvements in neurological function and reorganization of the representational map.Conclusions-The findings of this preliminary study demonstrate the potential of fMR imaging to assess changes in cortical representation before and after surgical intervention in patients with CSM. A future study involving a larger cohort of patients as well as the stratification of patients with CSM, based on the aforementioned factors that influence cortical adaptation, will allow a more detailed quantitative analysis.Address reprint requests to: Langston T. Holly, M.D., Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, 10833 Leconte Avenue, Los Angeles, California 90095. lholly@mednet.ucla.edu. Cervical spondylotic myelopathy is the most common form of acquired myelopathy; it commonly presents with hand dysfunction and gait difficulty 9,31 . The signs and symptoms of CSM are primarily caused by damage to nerve fibers within the cervical spinal cord, in particular those in the lateral corticospinal tract. Not surprisingly, the overwhelming majority of clinical and laboratory investigations into the pathogenesis of CSM have focused on spinal column or cord abnormalities 9,10,12,14,17,[26][27][28][29] . In contrast, the function of the cerebral cortex within the affected motor network has been largely understudied and represents a potential area of novel investigation. NIH Public AccessOne of the most studied adaptive mechanisms ...

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“…35 Not many studies have correlated the postoperative motor improvement with plasticity. 19 Some studies have shown adaptive changes in bilateral primary motor cortex (M1), supplementary motor area (SMA), premotor area (PMA), cingulate motor area, parietal cortex, and contralateral primary somatosensory cortex (S1) in cases of SCI [8][9][10][11][27][28][29]33,40 and cervical compressive myelopathy due to spondylosis. 13,14,23,38 In this study we aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using functional MRI (fMRI).…”

mentioning

confidence: 99%

Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery

Bhagavatula¹,

Shukla²,

Sadashiva³

et al. 2016

FOC

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OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level–dependent (BOLD) functional MRI (fMRI). METHODS Twenty-two patients having symptoms related to cervical cord compression due to spondylotic changes along with 12 age- and sex-matched healthy controls were included in this study. Patients underwent cervical spine MRI and BOLD fMRI at 1 month before surgery (baseline) and 6 months after surgery. RESULTS Five patients were excluded from analysis because of technical problems; thus, 17 patients made up the study cohort. The mean overall modified Japanese Orthopaedic Association score improved in patients following surgery. Mean upper-extremity, lower-extremity, and sensory scores improved significantly. In the preoperative patient group the volume of activation (VOA) was significantly higher than that in controls. The VOA after surgery was reduced as compared with that before surgery, although it remained higher than that in the control group. In the preoperative patient group, activations were noted only in the left precentral gyrus (PrCG). In the postoperative group, activations were seen in the left postcentral gyrus (PoCG), as well as the PrCG and premotor and supplementary motor cortices. In postoperative group, the VOA was higher in both the PrCG and PoCG as compared with those in the control group. CONCLUSIONS There is over-recruitment of sensorimotor cortices during nondexterous relative to dexterous movements before surgery. After surgery, there was recruitment of other cortical areas such as the PoCG and premotor and supplementary motor cortices, which correlated with improvement in dexterity, but activation in these areas was greater than that found in controls. The results show that improvement in dexterity and finer movements of the upper limbs is associated with recruitment areas other than the premotor cortex to compensate for the damage in the cervical spinal cord.

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Brain motor system function after chronic, complete spinal cord injury

Cited by 198 publications

References 59 publications

Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients

Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients

Cortical reorganization in patients with cervical spondylotic myelopathy

Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery

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