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PubMed2002

A community-centric internet portal for stereotactic and functional neurosurgery with a probabilistic functional atlas.

OBJECTIVE: This paper describes an Internet portal for stereotactic and functional neurosurgery with a probabilistic functional atlas (PFA) calculated from electrophysiological and neuroimaging data. This portal enables (1) data sharing among neurosurgeons; (2) the calculation of probabilistic functional maps of stereotactic target structures from a neurosurgeon's own data, optionally combined with data from other neurosurgeons, and (3) the construction and development of a PFA of the human brain by the neurosurgical community via the Internet. METHOD: The overall approach is done in three steps: (1) development and validation of the algorithm for PFA generation; (2) design and development of the portal for stereotactic and functional neurosurgery with tools for the rapid calculation, presentation, and use of the PFA, and (3) portal testing with the initial data acquired for 274 Parkinson's disease patients, 487 hemispheres, and 500 best contacts. This paper covers step 2 and some results from step 3. RESULTS: The Internet portal has been developed in Java and tested with the available data. Functions have been developed for: (1) data input, transfer, and editing; (2) data selection for PFA generation; (3) PFA generation; (4) PFA display and interactive manipulation, and (5) target planning. The portal has been put on the Internet for public use and so far more than 100 users downloaded it. CONCLUSION: The Internet portal for stereotactic and functional neurosurgery with a PFA potentially increases both the accuracy of targeting and the neurosurgeon's confidence. The portal may be useful for both experienced functional neurosurgeons who have studied numerous cases and novices in the field. The use of the PFA through this portal, and sharing and expanding its content by neurosurgeons represents a paradigm shift from manufacturer centric to community centric.

Anatomy, Artistic↗

PubMed1988

Treatment of severe renovascular hypertension by percutaneous transluminal renal angioplasty in patients with solitary functioning kidney. Effects on blood pressure and renal function.

In this study the effects of percutaneous transluminal renal angioplasty on blood pressure and renal function were studied in 9 hypertensive patients with stenosis of the main artery of a solitary functioning kidney. The outcome of the percutaneous dilatation of the renal artery stenosis, and the effects on blood pressure and renal function were evaluated for a mean period of 16.4 +/- 2.13 (SE) months (ranging from 3 to 65 months). A successful dilatation of the renal artery stenosis was shown in all the patients by the aortography performed 1 h after the procedure. At the discharge (7.8 +/- 0.9 days after dilatation), blood pressure was 'cured' in 2 patients and 'improved' in the remaining patients; renal function was improved in all patients who had reduced renal function. At the last follow-up, no restenosis was found in patients who repeated the follow-up angiography; blood pressure was 'cured' in 3 patients and 'improved' in 6 patients, and renal function appeared steadly improved. In contrast with other reports, our results demonstrate that percutaneous renal angioplasty is a safe and effective procedure and should be attempted before considering surgical intervention in patients with artery stenosis of a solitary functioning kidney.

Adult↗

PubMed1985

Right ventricular function in an operating room model of mechanical left ventricular assistance and its effects in patients with depressed left ventricular function.

Approximately 20% of patients who receive left ventricular assist devices (LVADs) for refractory cardiac failure after open heart surgery have had complications of right ventricular failure. To evaluate this problem in the diseased heart we simulated an LVAD in the operating room by bypassing and unloading the left ventricle with the heart-lung machine before routine open heart surgery. Right ventricular function was assessed in 12 patients with preoperative left ventricular ejection fractions of less than 0.55 (poor left ventricular function) (mean +/- SEM 0.40 +/- 0.03) and 10 patients with ejection fractions greater than 0.55 (normal left ventricular function) (0.63 +/- 0.02). Measurements before and during left ventricular bypass in the normal left ventricular function group revealed no change in cardiac output (from 5.7 +/- 0.6 to 5.8 +/- 0.4 liters/min), with a decrease in right ventricular end-diastolic pressure (from 8 +/- 2 to 6 +/- 1 mm Hg). However, in the poor left ventricular function group, cardiac output was increased significantly during left ventricular bypass from 4.5 +/- 0.2 to 5.3 +/- 0.4 liters/min and right ventricular end-diastolic pressure was decreased significantly from 13 +/- 2 to 8 +/- 2 mm Hg. During bypass there were significant reductions in mean pulmonary arterial pressure from 17 +/- 3 to 10 +/- 2 mm Hg in the normal left ventricular function group and from 27 +/- 3 to 12 +/- 2 mm Hg in the poor left ventricular function group. These measurements reflect passive changes in pulmonary pressures due to reductions in left ventricular filling pressure during left ventricular bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2002

HEN1 functions pleiotropically in Arabidopsis development and acts in C function in the flower.

Four classes of floral homeotic MADS domain proteins specify the identities of the four organ types in an Arabidopsis flower. While the activities of the MADS domain proteins are essentially confined to the flower or to the inflorescence, several genes, such as APETALA2, HUA1 and HUA2, also act outside the flower in addition to their organ identity functions inside the flower. We identified a new gene, HUA ENHANCER 1 (HEN1) from a sensitized genetic screen in the hua1-1 hua2-1 background that is compromised in floral homeotic C function. We showed that HEN1, like the C function gene AGAMOUS, acts to specify reproductive organ identities and to repress A function. HEN1 also shares AG's non-homeotic function in controlling floral determinacy. HEN1 may achieve these functions by regulating the expression of AG. hen1 single mutants exhibit pleiotropic phenotypes such as reduced organ size, altered rosette leaf shape and increased number of coflorescences, during most stages of development. Therefore, HEN1, like the A function gene AP2, plays multiple roles in plant development as well as acting in organ identity specification in the flower. HEN1 codes for a novel protein and is expressed throughout the plant.

Amino Acid Sequence↗

PubMed2002

Systolic heterogeneity of transmural myocardial function in normal subjects: physiological functional heterogeneity.

Because of the lack of a clinical method for assessing the transmural myocardial function, few studies on the heterogeneity during the myocardial contraction/relaxation sequence inside the human ventricular wall have been reported, despite the fact that the importance of the pathophysiology in the transmural heterogeneity has been stressed in previous experimental studies. We studied the transmyocardial functional heterogeneity of the basal anteroseptal segment in normal subjects (n = 8, 40.0 +/- 12.8 year, male), adopting the novel high resolution Doppler measurement "Phased Tracking Method". Each transmural layer of 0.75 mm thickness showed functional heterogeneity (physiological transmural functional heterogeneity), namely larger thickening occurred in the left ventricular endocardial side (right side 1/3: 26.1 +/- 5.2% of the total wall thickness, middle 1/3: 31.9 +/- 2.7%, left side 1/3: 42.1 +/- 6.4%) and the peak thickening shifted smoothly in time from the middle layers to the left subendocardial side during the contraction period. We concluded that transmural functional heterogeneity does exist in normal subjects as well as in the experimental animals of previous reports. Smooth and coordinate myocardial layer contraction across the ventricular wall (physiological transmural functional heterogeneity) is fundamental to maintain the normal ventricular function.

Adult↗

PubMed2000

[Diastolic function of the left ventricle and congestive heart failure with normal systolic function].

Mechanical performance of the heart depends on the physiologic interplay of its systolic and diastolic function. However, the cardiologist is used to defining left ventricular (LV) function only in terms of ejection fraction, cardiac output and blood pressure, thus observing only systolic function. In the last 10 to 15 years experience has revealed that, despite the presence of a normal LV systolic function, alterations of LV diastolic function may impair exercise tolerance and may be responsible for the clinical picture of about 30% of patients with a definite diagnosis of congestive heart failure. Doppler echocardiography has emerged as the most feasible and accurate noninvasive technique in assessing LV diastolic function in the clinical setting. Combined Doppler evaluation of transmitral and pulmonary venous flow velocity recordings, by transthoracic approach, allows us to obtain clinically relevant information on LV relaxation, LV filling, LV compliance, and LV end-diastolic and mean filling pressure, as well as on left atrial function, in more than 95% of patients referred to the echo-lab. With this combined evaluation different types of filling patterns have been identified. Clinical evaluation, together with structural/functional information obtained by M-mode and two-dimensional echocardiography, and mainly with detailed analysis of these LV filling patterns by Doppler, allow for a fairly accurate identification of various diastolic abnormalities, as well as the presence of diastolic dysfunction, i.e., increased filling pressures. Diastolic failure, characterized by the association of diastolic dysfunction and symptoms of pulmonary venous congestion, can now be more precisely identified following the criteria established by the Working Group on Diastolic Heart Failure of the European Society of Cardiology. Echo-Doppler age-adjusted normal values of indices of impaired LV relaxation and filling, along with cut-off values of Doppler signs of reduced compliance or increased filling pressures have been defined by the Working Group, and are herewith reported for practical purposes. Furthermore, as a reference for an advanced echo-lab, a "decalogue" of diastological performances is suggested.

Diastole↗

PubMed2001

Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy.

BACKGROUND: Quality of life (QOL) after a diagnosis of cancer varies considerably across individuals. Treatment-related factors that predict QOL for women who are diagnosed with breast carcinoma require further specification. This study was designed to develop a measure of perceived aesthetic (e.g., breast shape) and functional status (e.g., pain, mobility) after breast-conserving surgical treatment (BCT) and radiotherapy, to examine the relations of these indicators with patient QOL, and to determine whether these relations varied as a function of diagnosis duration. METHODS: Women (n = 185 patients) who underwent BCT and radiotherapy for Stage 0-II disease for whom the diagnosis duration ranged from 3 months to 18 years completed assessments of background information, perceived cosmetic and functional treatment outcomes, and QOL. Medical data also were obtained from medical charts. RESULTS: The Breast Cancer Treatment Outcome Scale (BCTOS) produced a coherent factor structure and three internally consistent subscales (i.e., cosmetic status, functional status, and breast specific pain) that demonstrated predictive validity. With patient age, diagnosis duration, and other BCTOS subscales controlled, greater breast specific pain predicted greater depressive symptoms (P < 0.01) and lower QOL related to mental health (P < 0.05) and physical health (P < 0.05). Cosmetic status predicted QOL related to physical health (P < 0.05). The relations of breast specific pain with QOL indicators varied somewhat as a function of diagnosis duration. CONCLUSIONS: Although considerable research on treatment-relevant outcomes has addressed appearance-related concerns, functional parameters have not been explored fully. Findings suggest that functional consequences of treatment, and particularly breast specific pain, also are significant influences on patient QOL.

Breast Neoplasms↗

PubMed2002

The impact of functional status and change in functional status on mortality over 18 years among persons with rheumatoid arthritis.

OBJECTIVE: To calculate mortality rate associated with rheumatoid arthritis (RA), to estimate the effect of initial functional status and of change in functional status on mortality among persons with RA, and to compare the mortality experience of such persons to that of the US population. METHODS: The study used a prospective panel of 1269 persons followed for a mean of 8.4 years (median 7 yrs, interquartile range 3-12, maximum 18). Mortality status was ascertained from contacts with next of kin, study physicians, and search of the National Death Index. The Kaplan-Meier method was used to calculate the proportion dying in each time interval, with and without stratification for initial functional status [Health Assessment Questionnaire (HAQ) score] or average change in functional status. Cox proportional hazards regression was used to establish the effect of functional status, demographic characteristics, and health status on mortality risk. RESULTS: There were 270 deaths among the 1269 persons with RA. After 18 years of followup the overall death rate was 39%. The death rates in the best through worst initial quartiles of HAQ score were 29, 33, 44, and 54%. The death rate was 51% among persons with declining HAQ score versus 31 and 32% among those with no change or improvement in this measure, respectively. Demographic and health status did not reduce the effect of HAQ or average change in HAQ on mortality risk. Compared to the US population, the persons with RA had a standardized mortality rate of 1.32. CONCLUSION: The persons with RA in this study had elevated mortality rates. Poor initial functional status and declining functional status significantly increased mortality risk among these persons with RA.

Activities of Daily Living↗

PubMed1977

Differentiation of functionally active mouse T-lymphocytes from functionally inactive bone marrow precursors.

An investigation has been made of the development of various T cell functions in lethally irradiated mice reconstituted with anti-0 treated spleen or bone marrow cells. Evidence is presented to show that both organs contain a post-thymic precursor pool able to regenerate by 15 days limited T cell responses in thymectomized recipients. A prethymic pool also exists in each organ able to regenerate, at a later date, first a suppressor T cell population and probably later, mature functional T cells involved in helper functions and cell mediated lympholysis. The spleen is apparently a better source of precursors of the suppressor cells than bone marrow, while a poorer source of precursors of the other T cell functions. All T cell functions investigated apparently first appear in large cells which undergo a reversion to small cells without necessarily maturing to their full potential reactivity. By following the kinetics of appearance of T cell functions, and the physical parameters of the cells with which these functions are associated, it is shown that PHA responding and Con A responding cells, cytotoxic T cell progenitors, helper T cells for antibody production and helper T cells for cytotoxicity induction can all at some stage of differentiation be separated from one another.

Animals↗

PubMed1987

Relationship among function, phenotype, and specificity in primary allospecific T cell populations: identification of phenotypically identical but functionally distinct primary T cell subsets that differ in their recognition of MHC class I and class II allodeterminants.

The goal of the present study was to evaluate the relationship among function, Lyt phenotype, and MHC recognition specificity in primary allospecific T cell populations. By using Lyt-2+ and L3T4+ T cells obtained from the same responder populations, we assessed the ability of T cells of each phenotype to generate cytotoxic effector cells (CTL) and IL 2-secreting helper T cells in response to either class I or class II MHC allodeterminants. It was found that a discordance between Lyt phenotype and MHC recognition specificity does exist in primary allospecific T cells, but only in one T cell subpopulation with limited functional potential: namely, Lyt-2+ T cells with cytotoxic, but not helper, function that recognize class II MHC alloantigens. Target cell lysis by these Lyt-2+ class II-allospecific CTL was inhibited by anti-Ia monoclonal antibodies (mAb), but not anti-Lyt-2 mAb, indicating that they recognized class II MHC determinants as their "restriction" specificity and not as their "nominal" specificity even though they were Lyt-2+. A second allospecific T cell subset with limited functional potential was also identified but whose Lyt phenotype and MHC restriction specificity were not discordant: namely, an L3T4+ T cell subset with helper, but not cytotoxic, function specific for class I MHC allodeterminants presented in the context of self-Ia. Thus, the present study demonstrates that primary allospecific T cell populations contain phenotypically identical subpopulations of helper and effector cells that express fundamentally different MHC recognition specificities. Because the recognition specificities expressed by mature T cells reflect the selection pressures they encountered during their differentiation into functional competence, these findings suggest that functionally distinct but phenotypically identical T cell subsets may be selected independently of one another during ontogeny. Thus, the existence of Lyt-2+ CTL specific for class II allodeterminants can be explained by the hypothesis that the association of Lyt phenotype with MHC recognition specificity results from the process of thymic selection that these Lyt-2+ effector cells avoid.

Animals↗

PubMed1985

The helper and suppressor functions of primate T cells elicited by a 185K streptococcal antigen, as compared with the helper function elicited by a 4K streptococcal antigen.

Helper and suppressor functions of human T lymphocytes that act on antibody-forming B cells were elicited by a large 185K streptococcal cell wall antigen. However, a small 4K streptococcal peptide elicited helper but no suppressor function. These differences in the functional activities of the large and small m.w. streptococcal antigens (SA) were confirmed by direct immunisation of rhesus monkeys with the 185K-SA and 4K-SA. Sequential studies have shown that whereas the 185K-SA elicits dose-dependent helper and suppressor activities, the 4K-SA elicits only helper function. Cell-depletion studies with human cells suggest that removal of T8+ cells by killing with OK.T8 and complement leads to a loss of suppressor and a broadening in the concentration of 185K-SA, which elicits helper activity. Because the 4K-SA does not elicit suppression, removal of T8+ cells does not affect this function. However, similar depletion of T4+ cells results in loss of the helper activities, both with the 185K-SA and 4K-SA, and again a broadening in the concentration of the 185K-SA, which elicits suppression. Direct comparison by autoradiography between 125I-labeled 185K-SA and 4K-SA suggests that both antigens can bind directly to monocytes or T8+ VV+ cells. Furthermore, both antigens can induce helper function if T4+ cells are reconstituted with either monocytes or T8+ VV+ cells. Attempts will now be made to sequence the amino acid determinants of the 185K-SA, so as to define the epitopes responsible for the two major regulating functions elicited by this antigen.

Animals↗

PubMed1987

The Functional Status Index: reliability and validity of a self-report functional disability measure.

Practical, reliable and valid functional assessment instruments are needed to assist health providers in planning a patient's discharge from hospital and determining the need for rehabilitation or longterm care. In addition, such instruments can be used in clinical and epidemiological research. Several methods of assessing functional performance are available. Patient self-report offers many advantages: cost, speed of obtaining assessments and the potential for assessing a wide range of complex functional dimensions. Criticisms of this approach center around the degree to which the data are a reliable and valid reflection of patient function. We developed a Functional Status Index (FSI) and assessed its validity in 47 patients with hip fracture by comparing it to the results of objective functional performance tests. Our results indicate that patient self-report of function, if conducted with a structured, standardized format, yields data with considerable reliability and validity.

Aged↗

PubMed1980

[The function W = (a--b e-ct)n, a generalization of the classical growth functions (author's transl)].

The generalization of Bertalanffy's function of length and mass growth and the extension of the Gompertz function to 4 parameters as exercised by the author (Sager 1979 b, a) leads to the equation W = (a--b e-ct)n with positive values of n, and b in the first case and negative ones for n and b in the second case. It is shown that with the range of values for n the above expression comprises all classical functions of organic growth, namely the logistic or Verhulst function (1838), the Mitscherlich function (1919), and the Pütter-Bertalanffy functions (1920, 1934) of length and mass development. Moreover, the limiting case n leads to +/- infinity leads to the Gompertz-function (1825), as can be verified by the increase ansatz of the universal expression. Beside graphs examples are given showing the evaluation of the parameters a, b, c and n in the case of free choice as well as c, d and n for the transformed notation W = W0 [(1--de-ct)/(1--d)]n with a given initial value W0 leaving three parameters for choice.

Animals↗

PubMed1994

Mechanism involved in the systemic suppression of antigen-presenting cell function by UV irradiation. Keratinocyte-derived IL-10 modulates antigen-presenting cell function of splenic adherent cells.

Exposure to UV radiation suppresses tumor rejection and delayed-in-time hypersensitivity reactions and depresses splenic APC function. Because almost all of the UV radiation is absorbed in the upper layers of the skin, it appears unlikely the direct irradiation of APC can account for the impaired ability of splenic adherent cells to present Ag after total-body UV exposure. Because UV-irradiated keratinocytes release IL-10, and in light of the well-documented effects of IL-10 on Ag presentation, we tested the hypothesis that keratinocyte-derived IL-10 is responsible for the systemic impairment of APC function following UV exposure. Injecting supernatants from UV-irradiated keratinocytes suppressed the ability of splenic adherent cells to present Ag. Treating the supernatants with anti-IL-10 mAb neutralized the suppressive effect. Similarly, when splenic adherent cells were isolated from mice exposed to UV radiation, APC function was suppressed. Injecting the UV-irradiated animals with anti-IL-10 restored APC function. In addition, spleen cells from UV-irradiated mice did not efficiently present Ag to Th1 clones, and injecting anti-IL-10 after UV exposure restored APC function. The reverse was observed when spleen cells from UV-irradiated mice were used to present Ag to Th2 clones; in which case, UV exposure enhances APC function, and anti-IL-10 reverses this effect. These findings suggest that UV-induced, keratinocyte-derived IL-10 can modulate splenic APC function.

Animals↗

PubMed1996

Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap.

OBJECTIVE: To construct a functional disability scale for the rheumatoid hand and to determine if this scale also assesses functional handicap. METHODS: Outpatients and inpatients with rheumatoid arthritis (RA) according to the ACR criteria answered a set of questions on their daily hand activities. Intrarater and interrater reliability were examined. Criterion referenced validity, and convergent and divergent validities were investigated. Factor analysis followed by varimax rotation was performed. Spearman's (rs) correlation coefficients between 2 quantitative variables were examined. The level of significance was p < 0.05. RESULTS: 96 patients with RA were recruited. The provisional scale had 41 questions. The elimination process left 18 hand activity questions with 6 levels of answers. The intrarater and interrater reliabilities of the scale were 0.97 and 0.96, respectively. Correlation of the scale's total score with visual analog scale (VAS) measure of functional handicap (rs = 0.78) showed good criterion referenced validity. The scale had good convergence with Revel's Functional Index (rs = 0.91) and a moderate relation to the Hand Functional Index (HFI) (rs = 0.58). The scale had a moderate, fair, or no relation to age, morning stiffness, pain measures, and hand swelling. The scale had 3 main factors by factor analysis. An English translation of the scale was validated. CONCLUSION: We have developed a practical functional disability scale for rheumatoid hands that also assesses functional handicap. It has 18 hand activity questions and has been validated in a French population.

Adolescent↗

PubMed1976

Renal function in experimental chronic hydronephrosis. III. Glomerular and tubular functions in relation to renal pelvic volume.

Studies of renal function comprising determination of exogenous creatinine clearance, urinary osmolality and TmG were performed on 23 dogs, for each kidney separately, after hydronephrosis with partial ureteric obstruction had been produced by ligation of one ureter over an indwelling catheter. A method for determining the volume of the hydronephrotic renal pelvis was developed and the degree of functional reduction was correlated to the degree of pelvic dilatation. In 11 cases the renal blood flow was determined by direct measurement. Statistically significant reductions of the glomerular and tubular functions were noted on the hydronephrotic side. TmG and the urinary osmolality showed the greatest percentual decreases and the TmG/GFR ratio the smallest. The decrease in this ratio was due to greater deterioration of tubular than of glomerular function. The renal blood flow was reduced on the hydronephrotic side in comparison with the intact side, but seemed relatively less affected than the glomerular and tubular functions. Compensation by the intact kidney resulted in masking of the deterioration on the hydronephrotic side; thus for the whole material the mean GFR and urinary osmolality for the two kidneys together remained essentially unchanged. No statistically significant correlation between the degree of functional reduction and the degree of pelvic dilatation was found. Such a correlation could therefore not be used in the individual case as an indication of the functional capacity of a kidney.

Animals↗

PubMed1988

[Loss of renal functional reserve following kidney transplantation and in patients with advanced disorders of liver function].

Renal functional reserve capacity was evaluated in healthy controls, kidney transplant recipients and patients with impaired liver function by simultaneous measurements of periodic clearances of inulin, PAH and creatinine every 30 minutes before, during and after infusion of an amino acid (AA) solution. During AA infusion glomerular filtration rate rose in 10 healthy controls to about 35% above basal values (inulin clearance from 107 +/- 6 to 144 +/- 7 ml/min, p less than or equal to 0.0005), renal plasma flow increased by 27% (PAH clearance from 530 +/- 25 to 675 +/- 40 ml/min, p less than or equal to 0.002). 8 renal transplant recipients with good and stable renal function (creatinine clearance above 65 ml/min) showed no rise in GFR and RPF, as did 10 patients with severe impairment of liver function and normal basal kidney function (creatinine clearance above 100 ml/min). The lack of renal functional reserve in kidney transplant recipients might indicate a hyperfiltration of the transplanted kidney. This could affect the longtime prognosis of these patients. The liver seems to play a role in the mediation of the amino acid-induced rise of GFR, supporting the hypothesis of a putative liver hormone regulating GFR after protein ingestion or AA infusion.

Adult↗

PubMed2000

The reorganization of sensorimotor function in children after hemispherectomy. A functional MRI and somatosensory evoked potential study.

Children who have suffered extensive unilateral brain injury early in life may show a remarkable degree of residual sensorimotor function. It is generally believed that this reflects the high capacity of the immature brain for cerebral reorganization. In this study, we investigated 17 patients who had undergone hemispherectomy for relief from seizures; eight of the patients had congenital brain damage and nine had sustained their initial insult at the age of 1 year or older. Sensorimotor functions of the hand were investigated using functional MRI (fMRI) during a passive movement task, somatosensory evoked potentials (SEPs) arising from electrical and vibration stimulation, and behavioural tests including grip strength, double simultaneous stimulation and joint position sense. On fMRI, two of the eight patients studied with this technique (one with congenital damage and one with damage acquired at the age of 3 years) showed activation in the sensorimotor cortex of the remaining hemisphere with passive movement of the hemiplegic hand. The location of the ipsilateral brain activation was similar to that found on movement of the normal contralateral hand, although the latter was greater in spatial extent. In one of these patients, a greater role was demonstrated for the ipsilateral secondary sensorimotor area (compared with the ipsilateral primary sensorimotor area) for movement of the hemiplegic hand than for movement of the normal hand. Median nerve stimulation of the hemiplegic hand showed reproducible early-latency ipsilateral SEP components in the remaining sensorimotor cortex in 10 of the 17 patients (five with congenital and five with acquired disease). Five of the patients who demonstrated ipsilateral electrical SEPs also showed ipsilateral vibration SEPs (two with congenital and three with acquired disease). The behavioural tests revealed residual sensorimotor function in 14 of the patients; however, not all of the patients who exhibited ipsilateral SEP or fMRI responses had residual sensorimotor function in the hemiplegic hand. Ipsilateral sensorimotor responses were demonstrated both in patients with congenital disease and those with acquired disease, suggesting that factors additional to aetiology and age at injury may influence the degree of residual sensorimotor function and cerebral reorganization.

Adolescent↗