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Cortical activation MR studies in brain disorders.

Principles and clinical applications of functional MR imaging activation studies are presented. The physical and physiologic basis for cerebral blood volume-, cerebral blood flow-, and oxygenation-based functional MR imaging techniques are reviewed. The methodology of blood oxygen level dependent (BOLD) functional MR imaging is emphasized. Applications to presurgical mapping of sensorimotor and language function in patients with vascular malformations, tumors, and other lesions near critical cortical areas are illustrated. Important new applications to neuropsychiatric diseases are highlighted.

Blood Volume↗

Functional MR imaging of language, memory, and sensorimotor cortex.

fMR imaging is a versatile technology that allows for the noninvasive identification of sensory, motor,and cognitive functions that may be impaired by surgical resection. fMR imaging provides the capacity to probe several brain functions, and when results are uncertain, to repeat or modify them. There are some limitations, MR contraindications to scanning, motion, and cooperation among them. Yet for most patients fMR imaging provides a reliable way to lateralize language dominance and to guide localization of language functions. Memory paradigms lag behind language in practical application, but the impediments to its utility will likely be resolved in the near future.

Brain Mapping↗

[Tethered cord syndrome in adults as a cause of disorders of bladder function].

The histories of two adults with tethered cord syndrome are presented. Slowly increasing bladder dysfunction, dysraphic disorder and increasing sensorimotor deficits gave rise to the suspicion of tethered cord syndrome. The release of the cauda equina by transsection of the thickened filum terminale and in one case removal of lipomatous tissue in addition improved the bladder function and the sensorimotor function substantially. Diagnostic procedures and aspects of the prognosis are discussed.

Adult↗

Development of short-term heterosynaptic facilitation at aplysia sensorimotor synapses in vitro is accompanied by changes in the functional expression of presynaptic serotonin receptors.

1. The sensorimotor synapse of Aplysia expresses various shortlasting changes in synaptic efficacy including homosynaptic depression (HSD) and heterosynaptic facilitation by serotonin (5-HT) either at nondepressed sensory neuron (SN) synaptic connections or at SN synaptic connections first depressed by HSD. We examined the temporal sequence of expression for these three forms of synaptic plasticity as synaptic connections between SN and target motor cell L7 were reestablished and stabilized in cell culture. The same cultures were reexamined at different time points. 2. We found that only HSD and facilitation of nondepressed synapses were expressed at "mature" levels on day 1 in culture, whereas facilitation of depressed connections was significantly weaker on day 1 than the facilitation evoked on day 4. 3. The late expression of 5-HT facilitation of depressed SN synaptic connections was not a result of a reduced capacity of two kinases activated by 5-HT (protein kinase A and protein kinase C) to evoke facilitation. Direct activation of the kinases with either cyclic AMP or phorbol esters evoked the synaptic facilitation both on day 1 and day 4. 4. The late expression of 5-HT facilitation of depressed SN synaptic connections was correlated with the late functional expression of receptors sensitive to 5-HT antagonists cyproheptidine or methiothepin. Both antagonists significantly interfered with 5-HT facilitation on day 4, but both had little effect on 5-HT facilitation of the same cultures examined on day 1. 5. Unlike the properties of SNs in the intact nervous system, both antagonists reduced significantly the excitability changes evoked by 5-HT when the SNs were plated either alone or with target cell L11 that fails to induce synapse formation. When cultured with L7, however, both antagonists evoked little change in 5-HT excitability. In the presence of L7, the SNs expressed the phenotype more typical of SNs in the intact nervous system. 6. The results suggest that target interactions not only influence the formation of chemical connections but they also may regulate the acquisition of specific plastic properties by the presynaptic neuron including the functional expression of receptors for neuromodulators.

Animals↗

Erythropoietin prevents long-term sensorimotor deficits and brain injury following neonatal hypoxia-ischemia in rats.

Perinatal asphyxia accounts for behavioral dysfunctions that often manifest as sensorimotor, learning or memory disabilities throughout development and into maturity. Erythropoietin (Epo) has been shown to exert neuroprotective effects in different models of brain injury including experimental models of perinatal asphyxia. However, the effect of Epo on functional abilities following cerebral hypoxia-ischemia (HI) in neonatal rats is not known. The aim of the present study is to investigate the effect of Epo on sensorimotor deficits and brain injury induced by hypoxia-ischemia. Seven-day-old rats underwent unilateral, permanent carotid artery ligation followed by 1 h of hypoxia. Epo was administered as a single dose immediately after the hypoxic insult (2000 U/kg). The neuroprotective effect of Epo was evaluated at postnatal day 42 by using a battery of behavioral tests and histological analysis. The results of the present study suggest that Epo treatment immediately after HI insult significantly facilitated recovery of sensorimotor function. Consistently, histopathological evaluation demonstrated that Epo significantly attenuated brain injury and preserved the integrity of cerebral cortex. These findings indicate that long-term neuroprotective effect of Epo on neonatal HI-induced brain injury might be associated with the preservation of sensorimotor functions.

Animals↗

[The time of a complex sensorimotor choice reaction in subjects with differing functional mobility of the nervous processes].

In 246 subjects (men, mean age--21 years) differing by the level of functional mobility (I-IV), statistically significant differences were found of mean values of latencies of complex sensorimotor reactions of choice (differentiation by meaning). Computation of Pearson correlation coefficients revealed significant negative connections between characteristics of functional mobility and values of latencies. On the basis of these data it is possible to consider the value of the latency of complex semantic reactions of choice as an information index of functional mobility of nervous processes.

Adult↗

[Functional magnetic resonance imaging in lesions in or near the sensorimotor cortex].

PURPOSE: To assess the efficiency of functional magnetic resonance imaging (fMRI) in demonstrating motor-sensorial cortical areas in mass lesions neighboring the perirolandic area and investigating its pre-operative sensitivity. MATERIALS AND METHODS: In the study, 20 right-handed patients with different types of intraxial and extraaxial mass lesions in or neighboring the perirolandic area were used. Of the all lesions, 6 were diagnosed as metastatic masses, 2 as oligodendroglioma, 2 as astrocytoma, 5 as glioblastoma multiforme, 2 as meningioma, 2 as arteriovenous malformations and 1 as porencephalic cyst. The study was performed on a 1.5 T unit. Images were acquired at the axial plane using T1 weighted spin echo, T2 weighted fast spin echo and fast FLAIR. Functional imaging was performed by blood-oxygen-level-dependent (BOLD) technique and single-shot gradient echo-planar sequence (SSEPI). During the sequence period a total of 420 images were acquired, each of which had 10 slices. By matching the resource functional images with T1 and T2 weighted anatomical images, the functional anatomy of the brain has been mapped. Sensorial-motor cortex has been activated by the finger-tapping-paradigm. RESULTS: Two patients could not included in the study because of extensive movement artifacts and meaningless BOLD answers. Eighteen of the patients had significant BOLD answers in bilateral peri-central sulcal area and in the center of the supplementary area. Activation areas were obtained neighboring the mass lesions and edema surrounding the lesion. CONCLUSION: fMRI can demonstrate motor-sensorial cortex in situations in which the anatomical order of perirolandic area has been changed by mass lesions. fMRI shows high sensitivity in the evaluation of lesions neighboring the perirolandic area preoperatively. Therefore fMRI can provide important information in patient selection, detection of different surgical choices and planning the surgical intervention.

Adult↗

Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence.

Twenty one patients with diabetic peripheral neuropathy, 18 with idiopathic faecal incontinence and 11 normal controls were studied with techniques of mucosal electrosensitivity, rectal distension for the quantitative assessment of anorectal sensation, and manometric and electromyographic tests for the assessment of anorectal motor function. An asymptomatic sensorimotor deficit was found in the anal canal of patients with diabetic peripheral neuropathy. Mucosal electrosensitivity thresholds in the anal canal were significantly higher (p less than 0.01 v controls) and fibre density of the external anal sphincter significantly raised (p less than 0.0001 v controls). Anal manometry and pudendal nerve terminal motor latencies were similar to controls. In patients with idiopathic faecal incontinence the tests of sensory and motor function also showed a sensorimotor neuropathy; compared with controls, mucosal electrosensitivity thresholds were significantly higher (p less than 0.002), anal canal resting and maximum squeeze pressures were significantly lower (p less than 0.05 and p less than 0.002 respectively), and pudendal nerve terminal motor latencies and fibre density of the external anal sphincter were significantly raised (both p less than 0.05). Sensory thresholds to rectal distension were similar in all groups. Pelvic floor sensorimotor neuropathy in diabetic patients has several features in common with that of patients with idiopathic faecal incontinence but its functional significance remains uncertain.

Adult↗

Functional subdivisions of the rat somatic sensorimotor cortex.

The behavioural impairments and subsequent recovery were studied in rats with circumscribed unilateral lesions in the somatic sensorimotor cortex (SMC). Lesions were made in the caudal forelimb region (CFL), the rostral forelimb region (RFL), the anteromedial cortex (AMC) or the hindlimb area. Rats with damage in the CFL produced a deficit in placing the forelimb contralateral to the lesion during exploratory locomotion on a grid surface. Rats with AMC damage circled in the direction ipsilateral to the lesion. Lesions in the CFL or AMC produced an ipsilateral somatosensorimotor asymmetry on the bilateral-stimulation test (responding to adhesive patches placed on the contralateral forelimb was slower) that recovered in 7 days following AMC lesions or 28 days following CFL lesions. Finally, RFL lesions produced an ipsilateral asymmetry on the bilateral-stimulation task that was more severe and enduring (recovery in 60 days). After behavioral recovery, the effects of an additional lesion placed in the homotopic contralateral cortex were examined (two-stage bilateral lesion). Rats receiving two-stage bilateral lesions in the RFL or CFL responded slower to tactile stimulation of the forelimb contralateral to the second lesion. In the case of CFL-damaged rats, placing deficits also appeared contralateral to the most recent injury. In contrast, rats receiving two-stage bilateral AMC lesions did not exhibit behavioral asymmetries following the second lesion. These results provide evidence to suggest that subdivisions of the rat SMC can be distinguished with lesion/behavioral experiments. Moreover, a comparison of the effects of unilateral and two-stage bilateral lesions may help in the parcellation of the rat SMC into functionally distinct subareas and provide a basis for studying the processes of recovery and maintenance of function following brain damage.

Animals↗

Force of voluntary exercise does not affect sensorimotor cortex activation as detected by functional MRI at 1.5 T.

Echo-planar brain images (1.5 T, 1-shot GRE, TR/TE = 3000/45) were acquired during 30-60 s cycles of repetitive (1.3-1.7 Hz) finger flexion exercise against light (0.24) vs heavy (1.40 kg) weights. In protocols during which exercise was alternated with periods of rest, active voxels were identified in the contralateral motor and somatosensory areas by cross-correlation against an on-off waveform. However, there was no significant difference between the responses to light vs heavy weights. In a continuous repetitive exercise protocol, in which only the weights were cycled, no force-correlated voxels were identified. Inasmuch as force-correlated neurons are known to be present in the primate cortex, the results illustrate a potential limitation of functional MRI studies based on the BOLD effect.

Adult↗

Functional and morphological characterization of neuropathy induced with 5-lipoxygenase inhibitor CGS 21595.

Peripheral toxic neuropathy induced in rats with a 5-lipoxygenase inhibitor CGS 21,595 was characterized using special functional tests and pathological procedures. Functional tests included measurement of grip strength, landing foot splay, assessment of sensorimotor and autonomic functions and monitoring of motor activity. Pathological procedures consisted of perfusion fixation, embedding in plastic, teasing of isolated nerve fibers, and light and electron microscopy. Male and female albino rats received the test article orally by gavage on 5 days per week. To characterize the development of the lesion animals treated with 1000 mg/kg were examined and sacrificed at 2-week intervals until termination at 10 weeks. In a separate study, the dose-effect relationship was examined in groups of animals treated with 50,200 or 1000 mg/kg for 10 weeks. Neurotoxicity occurred only in animals treated with 1000 mg/kg and was first detected following 4 weeks of treatment. Although there were no overt clinical signs of neurotoxicity, functional examination detected a reduction of grip strength, increased landing foot splay and reduced motor activity. Neuropathological examination revealed peripheral segmental demyelination affecting predominantly the Schwann cells in the ventral spinal nerve roots. Owing to its unusual localization in the nervous system and to subtlety of functional signs, peripheral segmental demyelination represents a special diagnostic challenge in toxicological safety studies.

1-Naphthylamine↗

Functional MR imaging of the human sensorimotor cortex during haptic discrimination.

This study attempted to determine whether haptic discriminations of shape (haptic task) activate the same tissue in the central cortical region of normal human subjects as do finger movements (opposition task). Opposition and haptic tasks both activated the central sulcus, as expected from previous imaging studies. The haptic task activated about 50% of the cortical territory activated by the opposition task. The results suggest that exploratory digital movements performed to collect precise somatosensory information and automatic movements performed during finger positioning activate partially overlapping parts of the sensorimotor cortex.

Brain Mapping↗

Within-session and between-session reproducibility of cerebral sensorimotor activation: a test--retest effect evidenced with functional magnetic resonance imaging.

The aim of the current study was to assess the reproducibility of functional magnetic resonance imaging (fMRI) brain activation signals in a sensorimotor task in healthy subjects. Because random or systematic changes are likely to happen when movements are repeated over time, the authors searched for time-dependent changes in the fMRI signal intensity and the extent of activation within and between sessions. Reproducibility was studied on a sensorimotor task called "the active task" that includes a motor output and a sensory feedback, and also on a sensory stimulation called "the passive task" that assessed the sensory input alone. The active task consisted of flexion and extension of the right hand. The subjects had performed it several times before fMRI scanning so that it was well learned. The passive task consisted of a calibrated passive flexion and extension of the right wrist. Tasks were 1 Hz-paced. The control state was rest. Subjects naïve to the MRI environment and non--MRI-naïve subjects were studied. Twelve MRI-naïve subjects underwent 3 fMRI sessions separated by 5 hours and 49 days, respectively. During MRI scanning, they performed the active task. Six MRI-naïve subjects underwent 2 fMRI sessions with the passive task 1 month apart. Three non--MRI-naïve subjects performed twice an active 2-Hz self-paced task. The data were analyzed with SPM96 software. For within-session comparison, for active or passive tasks, good reproducibility of fMRI signal activation was found within a session (intra-and interrun reproducibility) whether it was the first, second, or third session. Therefore, no within-session habituation was found with a passive or a well-learned active task. For between-session comparison, for MRI-naïve or non--MRI-naïve subjects, and with the active or the passive task, activation was increased in the contralateral premotor cortex and in ispsilateral anterior cerebellar cortex but was decreased in the primary sensorimotor cortex, parietal cortex, and posterior supplementary motor area at the second session. The lower cortical signal was characterized by reduced activated areas with no change in maximum peak intensity in most cases. Changes were partially reversed at the third session. Part of the test-retest effect may come from habituation of the MRI experiment context. Less attention and stress at the second and third sessions may be components of the inhibition of cortical activity. Because the changes became reversed, the authors suggest that, beyond the habituation process, a learning process occurred that had nothing to do with procedural learning, because the tasks were well learned or passive. A long-term memory representation of the sensorimotor task, not only with its characteristics (for example, amplitude, frequency) but also with its context (fMRI), can become integrated into the motor system along the sessions. Furthermore, the pattern observed in the fMRI signal changes might evoke a consolidation process.

Adult↗

The foundation of Piaget's theories: mental and physical action.

Piaget's late theory of action and action implication was the realization of a long history of development. A review of that history shows the central place of action in all of his theoretical assertions, despite the waxing and waning of other important features of his theories. Action was said to be the primary source of knowledge with perception and language in secondary roles. Action is for the most part not only organized but there is logic in action. Action, which is at first physical, becomes internalized and transformed into mental action and mental representation, largely in the development of the symbolic or semiotic function in the sensorimotor period. A number of alternative theories of cognitive development place primary emphasis on mental representation. Piaget provided it with an important place as well, but subordinated it to mental action in the form of operations. In this, as Russell claims, he paralleled Schopenhauer's distinction between representation and will. Piaget's theory of action was intimately related to the gradual development of intentionality in childhood. Intentions were tied to actions by way of the conscious awareness of goals and the means to achieve them. Mental action, following the sensorimotor period, was limited in its logical form to semilogical or one-way functions. These forms were said by Piaget to lack logical reversibility, which was achieved only in the sixth or seventh year, in concrete operations. Mental action was not to be fully realized until the development of formal operations, with hypothetical reasoning, in adolescence, according to the classical Piagetian formulation. This view of the child's logical development, which relied heavily on truth-table (extensional) logic, underwent a number of changes. First from the addition of other logics: category theory and the theory of functions among them. In his last theory, however, an even more radical change occurred. With the collaboration of R. Garcia, he proposed a logic of meanings that would require a recasting of his earlier truth-table-based operatory logic that he claimed explained the development of logical thought and problem solving. The new logic of meanings, influenced by Anderson and Belnap's (1975) logic of entailment, placed new emphasis on inferential processes in the sensorimotor period, introduced protological forms in the actions of the very young child, and proposed that knowledge has an inferential dimension. The consequence was that the late theory shifted emphasis to intentional (qualitative) logic and meaning from the earlier extensional (quantitative) logic and truth testing. The profound changes in Piaget's late theory requires a serious reevaluation of Piaget's entire corpus of research and theory; a task which is yet to be done. Seen in a new light, the late theory is much closer to intellectual currents associated with hermeneutic and semiotic traditions in their concern with meaning and interpretation and less, if at all, with truth. This, despite Piaget's couching of the new theory in a logical mode. The late theory added significant new elements to the theory of action and action-implication, and suggest that Piaget's, and his collaborator's, new research data, which were interpreted within the new theoretical framework, require corroboration and review. The question as to whether Piaget's assertions are at root metaphorical and lack psychological reality, which has followed his theories from its earliest days, arises as well with the assertions of the late theory. Possibly, even more so, since even a limited historical review of his theories points to a considerable concurrence between changes in the fundamental assumptions of his theories and intellectual currents of the times. In hindsight, Piaget's theories appear as "works in progress," down to his last theory. Yet, even in the end, he charted the direction of possible further progress.

Child↗

Functional coupling and regional activation of human cortical motor areas during simple, internally paced and externally paced finger movements.

We studied the activation and interaction of cortical motor regions during simple, internally paced and externally paced right-hand finger extensions in healthy volunteers. We recorded EEGs from 28 scalp electrodes and analysed task-related coherence, task-related power and movement-related cortical potentials. Task-related coherence reflects inter-regional functional coupling of oscillatory neuronal activity, task-related power reflects regional oscillatory activity of neuronal assemblies and movement-related cortical potentials reflect summated potentials of apical dendrites of pyramidal cells. A combination of these three analytical techniques allows comprehensive evaluation of different aspects of information processing in neuronal assemblies. For both externally and internally paced finger extensions, movement-related regional activation was predominant over the contralateral premotor and primary sensorimotor cortex, and functional coupling occurred between the primary sensorimotor cortex of both hemispheres and between the primary sensorimotor cortex and the mesial premotor areas, probably including the supplementary motor area. The main difference between the different types of movement pacing was enhanced functional coupling of central motor areas during internally paced finger extensions, particularly inter-hemispherically between the left and right primary sensorimotor cortexes and between the contralateral primary sensorimotor cortex and the mesial premotor areas. Internally paced finger extensions were also associated with additional regional (premovement) activation over the mesial premotor areas. The maximal task-related coherence differences between internally and externally paced finger extensions occurred in the frequency range of 20-22 Hz rather than in the range of maximal task-related power differences (9-11 Hz). This suggests that important aspects of information processing in the human motor system could be based on network-like oscillatory cortical activity and might be modulated on at least two levels, which to some extent can operate independently from each other: (i) regional activation (task-related power) and (ii) inter-regional functional coupling. We propose that internal pacing of movement poses higher demands on the motor system than external pacing, and that the motor system responds not only by increasing regional activation of the mesial premotor system, including the supplementary motor area, but also by enhancing information flow between lateral and mesial premotor and sensorimotor areas of both hemispheres, even if the movements are simple and unimanual.

Adult↗

Peripheral nerve function and metabolic control in diabetes mellitus.

Measurement of conduction velocity along the H reflex arc was used to study sensorimotor peripheral nerve function in diabetic patients during short- and long-term improvement of hyperglycemia. In ten type I diabetics a slight (p less than 0.05) conduction increase occurred after 6 hours of normal glycemia induced by an artificial endocrine pancreas. Similar but more prominent improvement occurred in twelve type I diabetics treated with continuous subcutaneous insulin injection for 6 months. The results suggest that nerve conduction slowing in diabetic patients stems partly from reversible, nonstructural abnormalities and partly from more slowly reversible morphological or chemical changes in peripheral nerve.

Adult↗

Ipsilateral motor cortex activation on functional magnetic resonance imaging during unilateral hand movements is related to interhemispheric interactions.

Distal, unilateral hand movements can be associated with activation of both sensorimotor cortices on functional MRI. The neurophysiological significance of the ipsilateral activation remains unclear. We examined 10 healthy right-handed subjects with and without activation of the ipsilateral sensorimotor area during unilateral index-finger movements, to examine ipsilateral, uncrossed-descending pathways and interhemispheric interaction between bilateral motor areas, using transcranial magnetic stimulation (TMS). No subject showed ipsilateral activation during right hand movement. Five subjects showed ipsilateral sensorimotor cortical activation during left hand movement (IpsiLM1). In these subjects, paired-pulse TMS revealed a significant interhemispheric inhibition of the left motor cortex by the right hemisphere that was not present in the 5 subjects without IpsiLM1. Neither ipsilateral MEPs nor ipsilateral silent periods were evoked by TMS in any subjects. Our observation suggests that IpsiLM1 is not associated with the presence of ipsilateral uncrossed-descending projections. Instead, IpsiLM1 may reveal an enhanced interhemispheric inhibition from the right hemisphere upon the left to suppress superfluous, excessive activation.

Adult↗