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Motor cortex stimulation is a minimally invasive surgical procedure used for pain control. The authors report their results treating two patients with typical Parkinson disease. Unilateral motor cortex stimulation proved to be beneficial bilaterally. Motor cortex stimulation may represent a cost-effective alternative to deep brain stimulation.
The macaque cerebellar nuclei all project topically onto a common thalamic field that is somatotopically organized in its projection to motor cortex. The complete overlap (except at the cellular level) of dentate and interpositus (and possibly fastigius and vestibular nuclei) projection onto the somatotopic thalamic field implies a complete body representation within each cerebellar nucleus, rather than a preferential representation of trunk in fastigius, proximal limb in interpositus and digits in dentate, as is sometimes supposed. Dentate receives from association cortex and generates the earliest signals, which assist motor cortex in initiating goal-directed movements. Interpositus receives the spinocerebellar projection and provides a fast input to motor cortex from the periphery, perhaps used in transcortical 'reflex' responses and in the control of oscillation. Fastigius and vestibular nuclei provide an opportunity for labyrinthine control of motor cortex activities-even for the digits. What is unique about cerebellar input to motor cortex? Recent work has emphasized two aspects: switching of a cerebellar signal on or off through Purkinje cell inhibition, and adjusting the magnitude of the signal to optimize motor performance.
Currently, non-invasive cerebral motor area stimulation is performed by magnetic or high voltage bifocal electrical stimulation. These techniques require non-conventional stimulators. The present study, performed on 28 normal subjects between 18 and 73 years of age, was designed to standardize a method of bifocal stimulation of motor cortex which uses low voltage conventional stimulators and therefore can be routinely used in electrophysiological laboratories. The hand motor area was stimulated by surface electrodes applied in Cz (cathode) and 8 cm lateral on the bimetal line (anode). Under the electrodes infiltration with Xylocaine 2% was made. Duration and intensity of the rectangular pulses were 150 microseconds and 200-250 Volts, respectively. The motor evoked potential (MEP) was recorded from opponens pollicis muscle by concentric needle electrodes and a slight voluntary contraction was made to facilitate the motor response. MEP latency and central motor conduction time (CMCT) were calculated for both sides. A significant relation with age and height in normal subjects was found only for the MEP latency. We computed also the equations expressing the normal variability between the sides of MEP latency and of CMCT.
In the primate cerebral cortex there are at least two somatotopically organized, nonprimary motor fields rostral to the primary motor area. To understand the functions of these multiple motor representations we have compared the neuronal activity in each of these fields while monkeys performed a trained motor task, using right, left or both hands. In the nonprimary motor cortex, activity in a number of neurons was related to the movement the animal chose and performed, whereas in the primary motor cortex, changes in the firing of most neurons were simply related to activity in the contralateral muscles. This result indicates that the nonprimary motor cortex is involved in higher-order coding of the laterality of the motor response, implying that it exerts its motor control function at a higher hierarchical level than its counterpart in the primary motor cortex.
The study of the motor cortex in behaving monkeys during the past 20 years has provided important information on the brain mechanisms underlying motor control. With respect to reaching movement in space, a key role of motor cortex in specifying the direction of reaching has been proposed on the basis of results from studies of the activity of cells and cell populations during reaching. These results and ideas are reviewed and discussed in the context of recent findings concerning the spinal mechanisms underlying reaching movements.
Animal studies have shown that cerebellar projections influence both excitatory and inhibitory neurones in the motor cortex but this connectivity has yet to be demonstrated in human subjects. In human subjects, magnetic or electrical stimulation of the cerebellum 5-7 ms before transcranial magnetic stimulation (TMS) of the motor cortex decreases the TMS-induced motor-evoked potential (MEP), indicating a cerebellar inhibition of the motor cortex (CBI). TMS also reveals inhibitory and excitatory circuits of the motor cortex, including a short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI) and intracortical facilitation (ICF). This study used magnetic cerebellar stimulation to investigate connections between the cerebellum and these cortical circuits. Three experiments were performed on 11 subjects. The first experiment showed that with increasing test stimulus intensities, LICI, CBI and ICF decreased, while SICI increased. The second experiment showed that the presence of CBI reduced SICI and increased ICF. The third experiment showed that the interaction between CBI and LICI reduced CBI. Collectively, these findings suggest that cerebellar stimulation results in changes to both inhibitory and excitatory neurones in the human motor cortex.
Motor evoked potentials after magnetic transcranial stimulation and the excitability of the motor cortex to increasing magnetic stimulus intensities were evaluated in six patients with hemiparesis after ischaemic stroke within 8 hours after stroke. The latencies of motor evoked potentials were normal in all patients. After stimulation of the ischaemic hemisphere we obtained responses comparable with the contralateral ones in two patients (mean NIH score 2 (SD 0)) and this group was completely asymptomatic after 15 days (NIH score 0). In four patients the excitability of the motor cortex involved by the ischaemia was reduced and magnetic motor threshold was higher than that of the spared motor cortex. This finding was associated with a poor motor recovery and the NIH score after 15 days was unchanged (NIH score 1.75 (SD 1.5)). The present data suggest that the evaluation of the excitability of motor cortex may offer a mean of predicting functional outcome following stroke.
OBJECTIVE: To map dynamic changes of primary motor cortex after total brachial plexus traction injury by using functional magnetic resonance imaging, and to explore underlying probable mechanisms. METHODS: Five patients with total traumatic root avulsions of the brachial plexus underwent varied kinds of nerve transfer to restore partially shoulder or elbow function. Four of them (cases 1, 3, 4, 5) accepted the first fMRI examination prior to surgery treatment, and four of them (cases 2, 3, 4, 5) accepted second or third or fourth fMRI follow-up re-examinations after surgery treatment. Maps of neuronal activation within the motor cortex were generated for both hands in each patient by using BOLD-fMRI and the cluster size and position were recorded. The motor tasks consisted of simple hand grasping of both hands respectively. Patients with paralytic hand were asked to complete task under "virtual" condition. The cluster size and intensity as well as location of motor activation within the primary motor cortex of the affected hand generated were compared with those of unaffected hand generated as reference in single subject, and the resultant maps of follow-up re-examinations were also compared with those of the prior examinations. RESULTS: All patients' unaffected hand movement generated strong signal change within the contralateral primary motor cortex. In contrast, the clusters generated by affected hand showed very small and lower intensity than usual (2 cases) or could not be induced (2 case) in the first examination that prior to surgery treatment and seemed larger gradually in the following re-examination with time increasing. CONCLUSION: Peripheral nerve injury can produced significant changes in the motor cortex of human brain. fMRI is a valuable tool to evaluate neural plasticity in motor cortex after peripheral nerve injury.
In 1870, Fritsch and Hitzig demonstrated that dogs have a motor cortex. In a chapter published 6 years later, Otto Soltmann studied the functional development of the motor cortex, which he believed functioned in willed movement. He was the first to show that the dog's motor cortex becomes electrically excitable at about 10 days of age, with the contralateral forepaw area appearing first. He also studied the effects of ablating the cortical motor regions unilaterally and bilaterally, and encountered a remarkable degree of sparing of function in his animals operated on as newborns, but not in older-operated dogs. Soltmann turned to the theory of functional take-over (vicariation) to account for the absence of deficits in his young animals. He was especially intrigued by the fact that electrical stimulation of a healthy motor cortex could produce bilateral matched movements, but only in dogs that sustained opposite motor cortex lesions very early in life.
Long-lasting potentiation of the cat motor cortex units induced by tetanic stimulation of the VL + SCx led to an increase of the motor cortex unit discharge rate. The findings suggest that co-activation of cortico-cortical and thalamo-cortical afferents modifies neuronal activity of the motor cortex at the specific site which receives convergent sensory input from the thalamus and the somatosensory cortex.
The organization of motor cortex and the sensorimotor overlap zone was examined by in-depth electrical stimulation using micromapping procedures in rats. The cutaneous somatic sensory, as well as the efferent motor projections to the hindlimb and forelimb sensorimotor overlap zone were studied in the same animals. Low-threshold movements were elicited from portions of 3 architectonic areas: the lateral agranular, dysgranular and granular areas. Cutaneous light touch projections occur only within the granular area. Cutaneous projections to, and motor projections from individual punctures in the granular overlap zone did not always involve homologous body parts. The total motor cortex exhibits a general musculotopic pattern of organization.
The effect of tetanic intracortical microstimulation (ICMS) of superficial layers of the motor cortex on unit discharges responding to stimulation of the peripheral receptive fields was examined in the motor cortex (area 4y). Single or multiple unit discharges were isolated from 15 recording sites near the stimulating electrodes. Following tetanic ICMS, the response to the same peripheral stimulation showed a long lasting increase at six recording sites, a long lasting decrease at two sites and transient increase or decrease at four sites. In the rest of the sites, tetanic ICMS had no effect. The results demonstrate the existence of use-dependent modification of information processing in the motor cortex and support the hypothesis that the motor cortex participates in learning motor skills.
OBJECTIVES: To investigate if intraoperative focused high frequency repetitive transcranial magnetic stimulation (rTMS) can localise the primary motor cortex without exposure of the cortical surface. METHODS: A high frequency train (357 Hz) of four suprathreshold magnetic stimuli was delivered transcranially to the region of the rolandic area during brain tumour operations in 12 patients. To induce a focal magnetoelectric field, the flat figure of eight coil (outer diameter of each loop 7 cm) was used. Motor evoked potentials (MEP) were recorded in eight muscles of the upper and lower contralateral extremities. The first stimulation site was 2.5 cm behind the bregma, the second site 2 cm, and the third site 4 cm dorsal to the first stimulation site. If no MEP were obtainable, stimulation was repeated in anteroposterior direction at more laterally located sites. Using neuronavigation, each positive stimulation site was correlated with the underlying cortical anatomy. RESULTS: Stimulation was performed at a total of 42 sites (in two patients, maximum stimulation at the three initial sites failed to evoke a motor response). In four patients, MEP were obtained only from one stimulation site. This site exactly overlayed the primary motor cortex. In eight patients, MEP could be elicited from more than one stimulation site. In seven of the eight patients, the site from which MEP with peak amplitudes were elicited, corresponded to the primary motor cortex. In total, the primary motor cortex was correctly identified on the basis of electrophysiological findings in 11 of 12 patients (92 %). In two patients, only the more lateral stimulation sites permitted MEP recording. CONCLUSION: Intraoperative focused rTMS is highly sensitive for localisation of the primary motor cortex. Focused rTMS as a localising instrument alleviates the need of motor cortex exposure and, thereby, can contribute to minimise the surgical approach to brain tumours in the rolandic area.
Shoulder joint-related motor cortex cells show continuously graded changes in activity, centered on a preferred movement direction, during active arm movements in 8 directions away from a central starting position (Georgopoulos et al., 1982). We demonstrate here that many of these cells show similar large continuously graded changes in discharge when the monkey compensates for inertial loads which pull the arm in 8 different directions. These load-dependent discharge variations are typically unimodal, centered on one load direction called the cell's load axis, and are often sufficiently continuous, symmetric, and broad as to show a good fit to a sinusoidal curve. A vectorial representation of cell activity indicates that the pattern of load-dependent activity changes in the population forms a signal whose direction is appropriate to compensate for the loads. The responses of single cells to different combinations of movement and load direction are often complex. Nevertheless, the mean activity of the sample population under any condition of movement direction and load direction can be described reasonably well by a simple linear summation of the movement-related discharge without any loads, and the change in tonic activity of the population caused by the load, measured prior to movement. The strength of the load-dependent discharge variation differs among cells. Cells can be sorted into 2 phasic and 2 tonic groups that show differing degrees of sensitivity to loads. In particular, it was found that the greater the degree of cell discharge variation associated with different actively maintained limb postures, the greater the activity changes caused by loads. No similar correlation was found for the degree of discharge variation during movement. Preliminary evidence suggests that phasic and tonic cell groups may be spatially segregated in the motor cortex. These observations are consistent with the idea that there exists in the motor cortex activity encoding aspects of movement kinematics, as well as movement dynamics. These observations are in agreement with studies of more distal arm joints, showing that the activity of certain motor cortex cells varies with the patterns of muscle activity and output forces required to produce a movement. These experiments extend the description of the control of the direction of movement of a multiple degree-of-freedom joint into the spatial (direction) domain to a greater extent than previously achieved.
Dopamine plays a broad role in motor control and practice-dependent plasticity. Here we tested, in eight healthy subjects, the effects of the dopamine receptor agonist cabergoline on motor cortical excitability because the state of motor cortex can strongly influence practice-dependent plasticity. Cabergoline enhances practice-dependent plasticity but the mechanisms are unknown. We used transcranial magnetic stimulation for testing of motor cortical excitability. A single dose of 2 mg of cabergoline increased short-interval intracortical inhibition, a measure of excitability of GABA-dependent inhibitory neural circuits, and decreased various excitatory measures (motor evoked potential amplitude and short-interval intracortical facilitation). Other measures of motor cortical (motor threshold, cortical silent period duration), spinal (peripheral silent period duration, F-wave) and neuromuscular excitability (maximum M-wave) remained unchanged. This shift in the balance from excitation to inhibition may assist, by improving the 'signal-to-noise ratio' in motor cortex, in the positive modulating effect of cabergoline on practice-dependent plasticity.
Neuropathic pain can be controlled by motor cortex stimulation using surgically-implanted electrodes in a majority of selected patients. Analgesic effects were also found to result from repetitive transcranial magnetic stimulation (rTMS) of the cortex. We report the case of a woman, in whom drug-resistant peripheral pain was controlled for 16 months by monthly sessions of motor cortex rTMS until a durable pain relief was obtained after surgical implantation of a cortical stimulator. This case illustrates the value of rTMS in helping patients to wait for surgery.
Tool use is a characteristic human trait, requiring motor skills that are largely learned by imitation. A neural system that supports imitation and action understanding by directly matching observed actions and their motor counterparts has been found in the human premotor and motor cortices. To test whether this "mirror-neuron system" (MNS) would be activated by observation of tool use, we recorded neuromagnetic oscillatory activity from the primary motor cortex of 10 healthy subjects while they observed the experimenter to use chopsticks in a goal-directed and non-goal-directed manner. The left and right median nerves were stimulated alternatingly, and the poststimulus rebounds of the approximately 20-Hz motor-cortex rhythms were quantified. Compared with the rest condition, the level of the approximately 20-Hz rhythm was suppressed during observation of both types of tool use, indicating activation of the primary motor cortex. The suppression was on average 15-17% stronger during observation of goal-directed than non-goal-directed tool use, and this difference correlated positively with the frequency of subjects' chopstick use during the last year. These results support the view that the motor-cortex activation is related to the observer's ability to understand and imitate motor acts.
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