Treatment of Supplementary Motor Area Syndrome

Abstract

Supplementary motor area syndrome is characterized by impaired initiation of volitional movement and commonly occurs following dominant or bilateral supplementary motor area (SMA) lesions. Initiation deficit is extremely disruptive to functional performance due to the pervasive nature of the impairment. We present a functional treatment approach, based on a Lurian model of neuropsychological intervention, involving the verbal regulation of movement. Using a single-case experimental design (i.e., extended ABAB), involving planned intermittent treatment withdrawal, we treated the severe initiation deficit of a 53-year-old male with supplementary motor area syndrome, secondary to a dominant SMA lesion. Significant gains were demonstrated in response latency, time to completion of multiple-step upper limb movements, activities of daily living (ADL), and mobility. Despite severely impaired initiation, the patient was able to learn and independently utilize a structured cuing sequence, which significantly increased his capacity to initiate purposeful voluntary movement.

Rank Signals in Four Areas of Macaque Frontal Cortex During Selection of Actions and Objects in Serial Order

“…Thus patients with SMA lesions show an increase in reaction time on a sequential digit task but not much impairment in the production of the correct sequence (Halsband et al 1993). To the extent that mild deficits of sequence production do occur, these are confined to the limb-movement domain and recover quickly (Bleasel et al 1996;Chassoux et al 1999;Hanlon et al 1995;Krainik et al 2001;Laplane et al 1977;Rostomily et al 1991;Zentner et al 1996; see also review by Goldberg 1985).…”

Neurocognitive and neurophysiological correlates of motor planning during familiar and novel contexts.

“…From a neuroanatomic standpoint, motor planning is thought to originate in bilateral supplementary motor regions, including the supplementary motor area proper (SMA), as well as pre-SMA and the cingulate motor area (Cunnington, Windischberger, & Moser, 2005; Ikeda & Shibasaki, 2003). Other evidence for the association between SMA and motor planning comes from clinical studies that demonstrate either reduced spontaneous movement following SMA lesions (e.g., akinetic mutism, Bannur & Rajshekhar, 2000; Hanlon, Clontz, Snow, & Thomas, 1995; Krainik et al, 2001; Nagaratnam, Nagaratnam, Ng, & Diu, 2004), or impaired inhibition of purposeful movements following lesions to SMA and surrounding structures (Feinberg, Schindler, Flanagan, & Haber, 1992; Giovannetti, Buxbaum, Biran, & Chatterjee, 2005; Nachev, Kennard, & Husain, 2008). Additionally, functional MRI research has demonstrated an association between the efficiency of motor planning and the connectivity strength between the SMA and the basal ganglia (Marchand et al, 2013), suggesting that motor planning may represent an index of the SMA integrity.…”

Bilateral supplementary motor area syndrome causing akinetic mutism following parasagittal meningioma resection

“…This approach helps with tracking recovery and with guiding neurorehabilitation. Both patients described here had resolution of their neurological findings while neuropsychological testing revealed persistent sensorimotor and ideomotor apraxia [24,52]. The profile was distinct from what one would expect in the case of compromise of corpuscallosum function [8,27,30,43,47,[53][54][55].…”

“…Firstly, it was more gradual in onset and the recovery spanned weeks to months necessitating careful supportive care. Motor recovery preceded return of speech and cognitive deficits, and improved from distal to proximal in the upper extremities before the lower extremities [24,29,30,33,52]. It was also characterized by a chronicity of apraxic deficits.…”