Left S1 Research Articles

Reader Response: Teaching NeuroImages: A Ruptured Lumbar Disc Mimicking Spinal Tumor.

We were very interested to read about this case regarding a 47-year-old man suffering from left S1 lumbosciatica, who displayed a ring-enhanced intradural lesion at the L5-S1 segment on the spinal MRI. The main preoperative diagnosis raised by the authors was a spinal tumor; however, intraoperative findings revealed a large, excluded disc herniation.1

"Non-Triangle Plane" Surgical Technique of Video-Assisted Thoracic Surgery Atypical Segmentectomy for Stage IA Non-Small-Cell Lung Cancer: Early Experience.

Objectives: To evaluate the safety and feasibility of a novel surgical technique (“non-triangle plane” technique) of two-port (mini-utility) video-assisted thoracic surgery (VATS) atypical segmentectomy (S3+S1+2c) with tunneling stapler for small-sized non-small-cell lung cancers (NSCLCs) located in left S3 close to the intersegmental plane between S3 and S1+2c.Materials and Methods: This retrospective descriptive study included 16 patients who, between April 2016 and December 2019, underwent a single two-port (mini-utility) VATS atypical segmentectomy (S3+S1+2c) with tunneling stapler technique for small-sized NSCLCs with a ground-glass opacity (GGO) rate of more than 50% by a constant surgical team in two hospitals. Perioperative data and survival data were collected and retrospectively analyzed. Postoperative follow-up was performed every 6 months.Results: Six patients were with adenocarcinoma in situ, and ten were with minimally invasive adenocarcinoma. The mean surgical margin was 14.06 ± 3.02 mm. The mean operation time was 53.88 ± 9.76 min. The mean duration of chest tube drainage was 4 ± 1.21 days, and the median length of postoperative hospital stay was 4 days. There was no perioperative morbidity and mortality. The median follow-up was 47.5 months (17–61 months). No recurrences occurred, and all patients were still alive at the last registered follow-up (May 31, 2021).Conclusion: Two-port (mini-utility) VATS atypical segmentectomy (S3+S1+2c) with tunneling stapler technique is a safe and feasible option for the treatment of small-sized NSCLCs located in left S3 close to the intersegmental plane between S3 and S1+2c.

Risk Factors for Invisible Intraoperative Markings After Virtual-Assisted Lung Mapping

BackgroundVirtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique that can be combined with bronchoscopic placement of a microcoil (VAL-MAP 2.0). VAL-MAP can identify unpalpable pulmonary lesions; however, the markings are occasionally deemed invisible intraoperatively. We investigated preoperative risk factors for invisible markings after VAL-MAP. MethodsWe prospectively performed preoperative VAL-MAP in patients at the University of Tokyo between January 2014 and June 2020. Data of 219 patients (257 lesions) and 857 markings were retrospectively reviewed. Dye markings were categorized as grade 0 (invisible) or 1-5 (visible). The risk factors for grade 0 markings were assessed using multiple logistic regression analysis. Subsegments of the bronchus showing grade 0 markings were also evaluated for 133 lesions and 504 markings without missing data for the target segment. ResultsSixty-one of the 257 lesions (24%) displayed ≥1 grade 0 markings. Seventy-six (8.9%) of the 857 markings were grade 0 intraoperatively. VAL-MAP 1.0 was performed for 202 (79%) and 25 lesions (10%) without and with electromagnetic navigation bronchoscopy, and VAL-MAP 2.0 with a microcoil was performed for 30 lesions (11%). Upper lobe markings were associated with a significantly increased risk of invisible markings. There was no significant difference in the frequency of grade 0 markings among the VAL-MAP methods. Among all bronchi subsegments, left B1+2c exhibited the highest rate of grade 0 markings. ConclusionsMarkings placed using VAL-MAP are more likely to be invisible for upper lobe pulmonary lesions. Injecting markings for lesions in the left S1+2c thus require caution.

Delineation of the intersegmental plane during a left S6 segmentectomy by infrared imaging

Delineation of the intersegmental plane during a left S6 segmentectomy by infrared imaging

Delineation of the intersegmental plane during a left S2 segmentectomy by selective bronchial insufflation

Delineation of the intersegmental plane during a left S2 segmentectomy by selective bronchial insufflation

Diversity of lymphatic flow in patients with lung cancer revealed by computed tomography lymphography

This study was conducted to verify the optimal extent of lymph node dissection or sampling during lung cancer surgery based on the sentinel node (SN) map created by computed tomography (CT) lymphography. From April 2010 to January 2015, patients with clinical stage I non-small-cell lung cancer, who were candidates for lobectomy or segmentectomy with standard hilar and mediastinal lymph node dissection, and in whom bronchus reached the tumour, were enrolled. An ultrathin bronchoscope was inserted to the target bronchus under the guidance of virtual bronchoscopic navigation images. CT images of the chest were obtained 30 s after 2.5 ml of iopamidol was injected. SNs were identified when the maximum CT attenuation value of the lymph nodes on postcontrast CT images increased by 30 Hounsfield units or more compared with the precontrast images. Patients underwent lobectomy with standard lymph node dissection. SNs were identified in 36 (87.8%) of the 41 patients. The average number of SNs was 1.6 (range, 1-4). There was 1 false negative case; therefore, the accuracy of SN identification was 97.2% (35/36). In 5 (13.9%) of 36 patients, SNs were outside the lobe-specific lymph node station range (#11i from right S1, #7 from right S1, #4R from right S8, #12u from right S8, #7 and #12l from left S1 + 2). CT lymphography demonstrated the diversity of lymphatic spreading patterns and there were cases in which lymph flows are found outside the lymph node dissection range.

Estimation of the relationship between the sacral hiatus and other dorsal sacral parameters using principle component analysis.

Correct localization of the sacral hiatus is essential for administering a successful caudal epidural block. The purpose of this study is to create a statistical model of sacral hiatus from dorsal sacral parameters to improve the location of the hiatus and thus, reduce the failure rate. The aim of this investigation was to examine the relationship of sacral hiatus morphology and dimension with sacral curvature. This study further examines the dorsal sacral parameters that could affect the sacral hiatus dimension. Adult, human, dry sacra and three-dimensionally reconstructed sacra from computed tomography imaging of normal subjects were included in the study and measured using digital Vernier calipers of 0.01mm accuracy and Geomagic freeform plus software, respectively. The most frequent shape of the sacral hiatus was an inverted V (48%) followed by inverted U shape (32%), an irregular shape (12.3%), an M shape (4.7) and an A shape (2.8%). The data were represented by mean and standard deviation. Sacra with M-shaped hiatus had the lowest hiatal length (14.21 ± 5.44mm), whereas sacra with an inverted V-shaped hiatus had the highest length (25.41 ± 11.3mm). The anteroposterior diameter of the sacral hiatus at the base in males and females was found to be 3.46 ± 1.48mm and 2.79 ± 0.83mm, respectively (P < 0.001). The distance between the caudal end of the median sacral crest and the apex of the sacral hiatus (7.90 ± 6.74mm, 4.4 ± 5.86mm) also revealed sexual dimorphism (P < 0.001). The correlations between most of the dorsal sacral parameters and length of the sacral hiatus are significant. The intercornual distance is also moderately correlated with the distance between right and left lateral sacral crest S1 level. Dorsal sacral parameters predicts variance of the sacral hiatus dimension from 40 to 73% and this could be utilized for statistical model of the sacral hiatus.

Clinical and experimental phenotype of azole-resistant Aspergillus fumigatus with a HapE splice site mutation: a case report

BackgroundThe recent increase in cases of azole-resistant Aspergillus fumigatus (ARAf) infections is a major clinical concern owing to its treatment limitations. Patient-derived ARAf occurs after prolonged azole treatment in patients with aspergillosis and involves various cyp51A point mutations or non-cyp51A mutations. The prognosis of patients with chronic pulmonary aspergillosis (CPA) with patient-derived ARAf infection remains unclear. In this study, we reported the case of a patient with ARAf due to HapE mutation, as well as the virulence of the isolate.Case presentationA 37-year-old male was presented with productive cough and low-grade fever. The patient was diagnosed with CPA based on the chronic course, presence of a fungus ball in the upper left lobe on chest computed tomography (CT), positivity for Aspergillus-precipitating antibody and denial of other diseases. The patient underwent left upper lobe and left S6 segment resection surgery because of repeated haemoptysis during voriconazole (VRC) treatment. The patient was postoperatively treated with VRC for 6 months. Since then, the patient was followed up without antifungal treatment but relapsed 4 years later, and VRC treatment was reinitiated. Although an azole-resistant isolate was isolated after VRC treatment, the patient did not show any disease progression in either respiratory symptoms or radiological findings. The ARAf isolated from this patient showed slow growth, decreased biomass and biofilm formation in vitro, and decreased virulence in the Galleria mellonella infection model compared with its parental strain. These phenotypes could be caused by the HapE splice site mutation.ConclusionsThis is the first to report a case demonstrating the clinical manifestation of a CPA patient infected with ARAf with a HapE splice site mutation, which was consistent with the in vitro and in vivo attenuated virulence of the ARAf isolate. These results imply that not all the ARAf infections in immunocompetent patients require antifungal treatment. Further studies on the virulence of non-cyp51A mutations in ARAf are warranted.

Superior Lingular S4 Segmentectomy

Although segmentectomy has become a routine procedure, atypical segmentectomies are less popular than their typical counterparts, probably because anatomic and surgical data are lacking. The left superior lingular S4 segment is considered relatively small, usually resected along with other segments. However S4 segment size varies among patients, and resection of this single segment can be a valuable lung-preserving procedure in carefully selected patients with tumors located at the border of the upper division and lingular segments. We present here the anatomic and surgical features required for a methodologic left S4 segmentectomy based on our experience and the literature.

The application of virtual segmentectomy based on three-dimensional computed tomography and angiography in thoracoscopic segmentectomy for children and infants.

The purpose of this retrospective study was to evaluate the efficacy of anatomic thoracoscopic pulmonary segmentectomy performed based on three-dimensional computed tomography bronchography and angiography (3D-CTBA) in children and infants. Totally, 22 patients received thoracoscopic segmentectomy from October 2019 to February 2020. The procedures were performed virtual segmentectomy based on 3D-CTBA. The preoperative planning depended on the 3D-CTBA result. All of the 22 cases ( 1 left S1, 1 right S3, 1 left S1 + 2, 1 left S1 + 2 + 3, 1 left S4 + 5, 1 right S6, 1 right S10, 1 left S10, 2 right S9 + 10, 3 left S9 + 10, 1 right S7 + 8 + 9 + 10, 8 left S7 + 8 + 9 + 10) were received thoracoscopic segmentectomy successfully. The mean procedure length was 76.6 ± 17.2min, and the intraoperative blood loss was 16.5 ± 2.8ml. The mean duration of chest tube insertion was 3.2 ± 0.7 days, and the mean hospital stay was 8.2 ± 2.8 days. Postoperative complications included infection (n = 1), atelectasis (n = 1), hydropneumothorax (n = 1) and pneumothorax (n = 1). No recurrence or mortality was observed during the short-term follow-up period of 3months. Based on the 3D-CTBA technique, the specific pulmonary segments invaded by the lesions and the relationship between the corresponding pulmonary vessels and bronchi can be acknowledged before the operation, which is of positive significance for the resection of complex pulmonary segments and good preoperative surgical planning. It's worth popularizing in the pediatric population.

Subpleural Lymphatic Permeation in Colorectal Lung Metastases

A 71-year-old woman with a history of rectal cancer 2 years earlier was referred to our department to manage bilateral pulmonary nodules. A chest computed tomography scan showed one lung nodule in the right S1 (13 mm) segment and two nodules in the left S9 (30 mm) and left S10 (10 mm) segments. After resection of the right tumor, a wedge resection was scheduled for the left tumors. However, rosarylike structures were noted beneath the visceral pleura to the hilum (Figures 1A-1C, arrows). We suspected lymphatic invasion; hence, partial resection was considered inappropriate for R0 resection.

Osteoplastic laminectomy for resection of a ganglioneuroma at the sacral spine: A technical note

Osteoplastic laminectomy is a surgical procedure that enables a wide field during the surgery and enables preservation of the posterior vertebral column structure by refixing the lamina once separated. We performed an osteoplastic laminectomy for resection of a ganglioneuroma at the sacral spine, and improved previous lower limb pain. A 33-year-old woman complained of pain in the nerve root region of the left S1. Examination revealed an epidural tumor at the left S2 level and we planned to remove the tumor. By performing an osteoplastic laminectomy at the level of S1–S3, we could secure a wide view of the surgical site and reliably resect the tumor. Pathological examination revealed that the resected tumor was a ganglioneuroma that had a possibility of malignant conversion. The postoperative course of our patient was favorable and no complaint was heard about surgical site pain postoperatively. There has been no tumor recurrence for more than 2 years. Osteoplastic laminectomy is considered to be a useful technique for epidural tumors at the sacral spine.

Region-Specific Effects of 10-Hz Transcranial Alternate Current Stimulation Over the Left Posterior Parietal Cortex and Primary Somatosensory Area on Tactile Two-Point Discrimination Threshold.

Changes in α-band cortical oscillatory activity (8–13 Hz) affect perception; however, how these changes in the left posterior parietal cortex (PPC) and primary somatosensory cortex (S1), which play different roles in determining the two-point discrimination (TPD) threshold, affect TPD threshold remains unelucidated. Therefore, to determine TPD threshold, we aimed to investigate the function of the left PPC and S1 by applying α-band transcranial alternating current stimulation (α-tACS; 10 Hz). TPD threshold was examined at the pad of the right index finger, contralateral to the stimulation site, in 17 healthy adults using a custom-made, computer-controlled, two-point tactile stimulation device, with random application of either active or sham α-tACS over the left PPC (Experiment 1) and left S1 (Experiment 2). Then, 50% TPD threshold was obtained in the active and sham conditions via logistic regression analysis. Afterward, we compared the difference between the active and sham conditions at 50% TPD threshold in each region and found that α-tACS reduced TPD threshold when applied over the left PPC (P = 0.010); however, its effect was insignificant when applied over the left S1 (P = 0.74). Moreover, a comparison of the change in 50% TPD threshold among the regions revealed that α-tACS applied over the left PPC significantly reduced TPD threshold compared with that applied over the left S1 (P = 0.003). Although we did not reveal the actual changes in cortical activity induced by α-tACS, this is the first empirical evidence that α-tACS applied over the left PPC and left S1 exerts region-specific effects on determining TPD threshold assessed in the contralateral index finger pad by stimulation.

Amplitude of Low-Frequency Oscillations in Major Depressive Disorder With Childhood Trauma.

Major Depressive Disorder (MDD) with childhood trauma is one of the functional subtypes of depression. Frequency-dependent changes in the amplitude of low-frequency fluctuations (ALFF) have been reported in MDD patients. However, there are few studies on ALFF about MDD with childhood trauma. Resting-state functional magnetic resonance imaging was used to measure the ALFF in 69 MDD patients with childhood trauma (28.7 ± 9.6 years) and 30 healthy subjects (28.12 ± 4.41 years). Two frequency bands (slow-5: 0.010–0.027 Hz; slow-4: 0.027–0.073 Hz) were analyzed. Compared with controls, the MDD with childhood trauma had decreased ALFF in left S1 (Primary somatosensory cortex), and increased ALFF in left insula. More importantly, significant group × frequency interactions were found in right dorsal anterior cingulate cortex (dACC). Our finding may provide insights into the pathophysiology of MDD with childhood trauma.

Periosteal Variety of Sacral Osteoid Osteoma Encroaching into the Spinal Canal – Treatment with a Tubular Retractor System: Case Report

Background: Osteoid osteomas are benign primary bone tumors with a predilection for posterior elements of the spinal column. Complete surgical excision through a traditional open approach is the treatment of choice for patients not responding to non-steroidal anti-inflammatory medications and patients with contraindications for nidus ablation. The study aims to highlight an alternative minimally invasive technique for complete surgical excision of osteoid osteoma encroaching into the spinal canal. Methods: We report a case of 22 years-old obese male suffering from left S1 radiculopathy and night pain. Magnetic resonance imaging and computed tomography (CT)-scan of the lumbosacral region revealed a benign bony lesion of size 13 mm × 11 mm × 8 mm encroaching from S1 lamina into the spinal canal and compressing left S1 root. Peri-lesional bony sclerosis and soft tissue edema were absent. In view of obesity and a small size of the lesion, it was decided to remove the lesion with a tubular retractor system under general anesthesia. Complete resection of the lesion was carried out sparing the L5-S1 facet, with a minimally invasive approach. Results: Patient had complete symptomatic improvement after the surgery. Histopathology showed interconnected trabeculae of woven bone matrix rimmed by osteoclasts consistent with the diagnosis of osteoid osteoma. Post-operative CT scan showed that the nidus was removed completely and important structures such as facet, pedicle, and midline posterior ligament complex were preserved. The patient resumed his daily activities and remained symptoms-free at the end of 6 months of follow-up. Conclusion: Minimally invasive surgery using a tubular retractor system can be safe and effective alternative to traditional open surgery for excision of osteoid osteoma from the posterior elements. Faster recovery, minimal tissue damage, and early return to work are added advantages for an obese patient undergoing minimally invasive total surgical excision. Keywords: Benign bone tumors, Sacral spine, Osteoid osteoma, Periosteal osteoid osteoma, Minimally invasive spine surgery, Tubular retractor system

Extended Sleeve Lobectomy is an Alternative for Centrally Located Lung Cancer With Superior Short- and Long-term Outcomes

IntroductionExtended sleeve lobectomy (ESL) is a feasible alternative to pneumonectomy; however, the survival benefit is unclear, and preoperative selection of potential candidates for ESL remains a problem. Matierals and MethodsESL was performed on selected candidates with double sleeve lobectomy for more than 1 lobe (eg, left upper lobe and S6 segment resection). Three-dimensional (3-D) reconstruction was routinely validated. Patients were candidates for ESL if the predicted distal stump length was > 6 mm and the pulmonary vein of the remaining segments was not invaded. ResultsOf the 1809 patients with centrally located lung cancer for surgical resection, 86 patients with tumors invading more than 1 lobe were enrolled in the study. After evaluation by 3-D reconstruction, 22 (95.7%) of 23 selected candidates underwent ESL, and 63 patients were deemed unsuitable for ESL and underwent pneumonectomy (43 cases) or thoracic exploration (20 cases). Surgical outcomes between the ESL and pneumonectomy groups were similar in terms of complications, blood loss and surgical duration, but the 6-minute walking distance was significantly improved in the ESL group (371 ± 111 m vs. 191 ± 55 m, respectively; P < .001). The mean forced expiratory volume in 1 second was 1.6 ± 0.3 L at the 1-year follow up examination in the ESL group. In the survival analysis, no difference was observed between the ESL and pneumonectomy groups in terms of 3-year overall survival (85% vs. 89%, respectively; P = .626) and 3-year disease-free survival (75% vs. 76%, respectively; P = .625). ConclusionsESL is a feasible and superior surgical procedure in terms of its short-term and long-term outcomes, and we suggest 3-D reconstruction to identify candidates for ESL.

Decreased task‐evoked functional connectivity in the descending pain modulatory network in Alzheimer’s disease

AbstractBackgroundPeople with Alzheimer’s disease (AD) may suffer from alterations in the descending pain modulatory network (DPMN). Adults with AD receive fewer analgesic pain medications and report pain less frequently than healthy controls. This study examines possible alterations in task‐evoked functional connectivity (TEFC) in response to thermal pain in several structures comprising the DPMN. We hypothesize that adults with AD will demonstrate decreased TEFC between DPMN regions.MethodThe sample consisted of 61 adults, 31 people with Alzheimer’s disease (AD; Mage = 77) and 30 healthy controls (HC; Mage = 73). The groups did not differ on socioeconomic status, current or average pain, or state or trait anxiety scores. Age and depression scores differed between groups and were controlled. Participants completed 4 pseudorandomized fMRI sessions using a passive thermal pain induction task consisting of warmth, mild pain, and moderate pain temperature thresholds. Regions of interest were selected a priori: bilateral primary somatosensory cortex (S1), bilateral anterior insula (aINS), bilateral posterior insula (pINS), anterior cingulate cortex (ACC), and the periaqueductal gray (PAG). Psychophysiological interactions (PPI) analysis was completed using CONN v18.b. Motion correction was performed using Artifact Detection Tools and fMRI sessions for which greater than 20% of the timeseries exceeded 2 mm normalized motion were excluded from the analysis. Age and AD‐related differences in cerebral tissue volume were controlled. Contrasts for this analysis were chosen to be mild pain &gt; warmth and moderate pain &gt; warmth to subtract innocuous stimulus from noxious stimuli.ResultCompared to healthy controls, adults with AD exhibited decreased TEFC between the R S1 and L S1 for mild pain &gt; warmth (T = ‐2.03, p = 0.047), and decreased TEFC between the PAG and ACC for moderate pain &gt; warmth (T = ‐2.18, p = 0.033).ConclusionFindings suggest that in people with AD, decreased connectivity between left and right S1 may indicate altered sensory processing of neural input. Evidence of decreased connectivity between the PAG and ACC in adults with AD may indicate an inability to modulate endogenous opioid systems within the brain and may lead to increased suffering from pain.

The left main bronchus transected incorrectly during video-assisted thoracoscopic lobectomy: a case report

BackgroundSeveral severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected.Case presentationA 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy.ConclusionsWe experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

Combined Wireless Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, and Peripheral Nerve Stimulation for Treating Low Back Pain

Background: Neuromodulation has undergone significant advances over the past decade, particularly when the DRG and PNS modalities evolved to target conditions that are hard to cover by conventional SCS. The availability of a variety of stimulation modalities allows for a customized approach. Case Presentation: A 49-year-old man presented with low back and buttock pain. The patient had a history of chronic lower back pain, L4/L5 and L5/S1 facet hypertrophy, a 3-mm left paracentral and foraminal disc protrusion minimally involving the left S1 nerve root, and right low back/buttock/hip pain after previous surgical removal of an episacroiliac lipoma on the right sacroiliac joint. Despite multiple therapies such as oral opioids, anticonvulsants, and physical therapy, the patient continued to experience right lower back and buttock pain. Conclusion: The patient’s pain scores decreased from a baseline score of 8 out of 10 without medication to a 1 out of 10 without medication. The wireless SCS and PNS significantly reduced pain scores for this patient suffering from lower back, buttock, and hip pain. Key words: Dorsal root ganglion, low back pain, peripheral nerve stimulation, spinal cord stimulation

Increased functional sensorimotor network efficiency relates to disability in multiple sclerosis

Background: Network abnormalities could help explain physical disability in multiple sclerosis (MS), which remains poorly understood. Objective: This study investigates functional network efficiency changes in the sensorimotor system. Methods: We included 222 MS patients, divided into low disability (LD, Expanded Disability Status Scale (EDSS) ⩽3.5, n = 185) and high disability (HD, EDSS ⩾6, n = 37), and 82 healthy controls (HC). Functional connectivity was assessed between 23 sensorimotor regions. Measures of efficiency were computed and compared between groups using general linear models corrected for age and sex. Binary logistic regression models related disability status to local functional network efficiency (LE), brain volumes and demographics. Functional connectivity patterns of regions important for disability were explored. Results: HD patients demonstrated significantly higher LE of the left primary somatosensory cortex (S1) and right pallidum compared to LD and HC, and left premotor cortex compared to HC only. The logistic regression model for disability (R2 = 0.38) included age, deep grey matter volume and left S1 LE. S1 functional connectivity was increased with prefrontal and secondary sensory areas in HD patients, compared to LD and HC. Conclusion: Clinical disability in MS associates with functional sensorimotor increases in efficiency and connectivity, centred around S1, independent of structural damage.