Long-range plasticity between intact hemispheres after contralateral cervical nerve transfer in humans

Clinical article

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Object

Peripheral nerve injury in a limb usually causes intrahemispheric functional reorganization of the contralateral motor cortex. Recently, evidence has been emerging for significant interhemispheric cortical plasticity in humans, mostly from studies of direct cortical damage. However, in this study, a long-range interhemispheric plasticity was demonstrated in adults with brachial plexus avulsion injury (BPAI) who had received a contralateral cervical nerve transfer, and this plasticity reversed the BPAI-induced intrahemispheric cortical reorganization.

Methods

In this study, 8 adult male patients with BPAI were studied using PET scanning.

Results

The results indicated that the right somatomotor cortices, which may contribute to the control of the injured limb before brachial plexus deafferentation, still played an important role when patients with BPAI tried to move their affected limbs, despite the fact that the contralateral C-7 nerve transfer had been performed and the peripheral output had changed dramatically. Such findings are consistent with the results of the authors' previous animal study.

Conclusions

The brain may try to restore the control of an injured limb to its original cortex area, and a complicated change of peripheral pathway also can induce long-range interhemispheric cortical reorganization in human motor cortex.

Abbreviations used in this paper: BPAI = brachial plexus avulsion injury; CGM = cerebral glucose metabolism; fMR = functional MR; MRC = Medical Research Council; SMA = supplementary motor area; SMC = somatomotor cortex; SPM = statistical parametric mapping; TBI = traumatic brain injury; TMS = transcranial magnetic stimulation.

Article Information

Address correspondence to: Wen-Dong Xu, Ph.D., M.D., Department of Hand Surgery, Huashan Hospital, 12 Wulumuqi Middle Road, Shanghai 200040, People's Republic of China. email: wendongxu88@yahoo.com.cn.

*Drs. Zuo and Hua contributed equally to this study.

Please include this information when citing this paper: published online February 5, 2010; DOI: 10.3171/2010.1.JNS09448.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Diagram of the contralateral C-7 transfer operation.

  • View in gallery

    The SPM 3D render maps, showing brain areas with significant CGM increase in patients with flexion of the affected (left) wrist and fingers. Left SMC (thick red arrow), left SMA (thin red arrow), right SMC (thick blue arrow), and right SMA (thin blue arrow).

  • View in gallery

    The SPM 3D render maps showing brain areas with significant CGM increase in healthy volunteers with left wrist and finger flexion. Left SMC (thick red arrow), left SMA (thin red arrow), right SMC (thick blue arrow), and right SMA (thin blue arrow).

  • View in gallery

    The SPM 3D render maps showing brain areas with significant CGM decrease in patients with BPAI compared with healthy volunteers in the resting-state scan. Right SMC (thick blue arrow), and right SMA (thin blue arrow).

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