Unilateral Motor Research Articles

RASMUNSSEN ENCEPHALITIS IN YOUNG ADULT: A CASE REPORT

Rasmunssen encephalitis is a rare disease characterized by focal cortical inflammation with progressive extension and diffusion. Clinical features are continuous partial epilepsy non responsive to usual anti-epileptic therapy and unilateral motor deficit, corresponding with the IRM imaging to cerebral hemiatrophy. The disease mainly affects children but there are some acknowledged cases described in adolescent and adult life. This report aims to present a clinical case of a young female with seven years personal history of generalized epilepsy. Having a clinical and paraclinical evolution a suspicion of chronic focal Rasmunssen encephalitis took shape. During admission she suffered of weakness and involuntary movements in her left side, which gradually worsened in the last month and memory impairment also. Routine laboratory blood evaluation, inflammatory and infectious tests were within the normal range. Magnetic resonance imaging of the brain reveals T2 atrophy of the right cerebral hemisphere with a low displacement of median structures to the left and an abnormal hyper intensity signal on T2-weighted, along with FLAIR images. Electroencephalography showed a profoundly altered, slowed, asymmetrically with paroxysmal unilateral right slow activity record with high amplitude. Based on clinical criteria, MRI imaging and EEG we supported the diagnosis of Rassmunsen encephalitis.

Isolated unilateral lower motor neuron facial palsy as the presenting feature of Guillain Barre Syndrome in a child

Case report An 11 year old girl presented with inability to close the left eye and water drooling from left corner of the mouth while drinking for one day. There was no history of preceding illness or trauma. Examination revealed isolated lower motor neuron type left facial nerve palsy grade V according to the HouseBrackmann grading system. The rest of the neurological examination was normal with intact sensation. She was treated with oral acyclovir and prednisolone and was referred for physiotherapy. On day 3 of the illness, she developed difficulty in getting up from the squatting position. Examination revealed bilateral weakness of lower limbs (Grade 3) with absent ankle jerks along with the left sided lower motor neuron facial nerve palsy noted three days back. No sensory deficits were noted. During the next 24 hours, weakness progressed to involve both upper limbs and the right facial nerve (HouseBrackmann grade III). External ophthalmoplegia was not noted. Nerve conduction study done on the 4 day gave the following results as shown in Table 1.

Hemispheric asymmetry non-linear analysis of EEG during emotional responses from idiopathic Parkinson's disease patients.

Recent studies show right hemisphere has a unique contribution to emotion processing. The present study investigated EEG using non-linear measures during emotional processing in PD patients with respect to motor symptom asymmetry (i.e., most affected body side). We recorded 14-channel wireless EEGs from 20 PD patients and 10 healthy age-matched controls (HC) by eliciting emotions such as happiness, sadness, fear, anger, surprise and disgust. PD patients were divided into two groups, based on most affected body side and unilateral motor symptom severity: left side-affected (LPD, n=10) or right side-affected PD patients (RPD, n=10). Nonlinear analysis of these emotional EEGs were performed by using approximate entropy, correlation dimension, detrended fluctuation analysis, fractal dimension, higher order spectra, hurst exponent (HE), largest Lyapunov exponent and sample entropy. The extracted features were ranked using analysis of variance based on F value. The ranked features were then fed into classifiers namely fuzzy K-nearest neighbor and support vector machine to obtain optimal performance using minimum number of features. From the experimental results, we found that (a) classification performance across all frequency bands performed well in recognizing emotional states of LPD, RPD, and HC; (b) the emotion-specific features were mainly related to higher frequency bands; and (c) predominantly LPD patients (inferred right-hemisphere pathology) were more impaired in emotion processing compared to RPD, as showed by a poorer classification performance. The results suggest that asymmetric neuronal degeneration in PD patients may contribute to the impairment of emotional communication.

Mirror Visual Feedback-Induced Performance Improvement and the Influence of Hand Dominance.

Mirror visual feedback (MVF) is a promising technique in clinical settings that can be used to augment performance of an untrained limb. Several studies with healthy volunteers and patients using transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI) indicate that functional alterations within primary motor cortex (M1) might be one candidate mechanism that could explain MVF-induced changes in behavior. Until now, most studies have used MVF to improve performance of the non-dominant hand (NDH). The question remains if the behavioral effect of MVF differs according to hand dominance. Here, we conducted a study with two groups of young, healthy right-handed volunteers who performed a complex ball-rotation task while receiving MVF of the dominant (n = 16, group 1, MVFDH) or NDH (n = 16, group 2, MVFNDH). We found no significant differences in baseline performance of the untrained hand between groups before MVF was applied. Furthermore, there was no significant difference in the amount of performance improvement between MVFDH and MVFNDH indicating that the outcome of MVF seems not to be influenced by hand dominance. Thus our findings might have important implications in neurorehabilitation suggesting that patients suffering from unilateral motor impairments might benefit from MVF regardless of the dominance of the affected limb.

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy.

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.

Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach

ObjectiveThe anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation.MethodsWe retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications.ResultsOf 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus.ConclusionFor patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope.

Asimetría cerebral y dopamina: más allá de las implicaciones motoras en la enfermedad de Parkinson y hemiparkinsonismo experimental

Brain asymmetry could be defined as the existence of functional, anatomic or neurochemical differences between both hemispheres. It is a dynamic phenomenon, regulated by endogenous and exogenous factors. Its functional significance is poorly clarified and is only partially understood in very specific cases such as the relationship between the lateralized brain content of dopamine and its motor effects which is specially patent in Parkinson's disease. The asymmetric brain content of dopamine not only displays lateralized motor effects but also behavioral and autonomic asymmetric consequences. In fact, Parkinson's disease is characterized not only by unilateral motor symptoms that arise at the early stages, but has other non-motor symptoms such as autonomic or cognitive alterations that are also revealed asymmetrically. Brain asymmetry has been underestimated when analyzing the pathogeny of brain diseases and it has been partially studied only in some specific cases, such as Parkinson's disease. However, in order to appropriately understand some brain diseases such as Parkinson's disease, the need to consider this phenomenon has been highlighted.

Bilateral cerebellar activation in unilaterally challenged essential tremor.

BackgroundEssential tremor (ET) is one of the most common hyperkinetic movement disorders. Previous research into the pathophysiology of ET suggested underlying cerebellar abnormalities.ObjectiveIn this study, we added electromyography as an index of tremor intensity to functional Magnetic Resonance Imaging (EMG-fMRI) to study a group of ET patients selected according to strict criteria to achieve maximal homogeneity. With this approach we expected to improve upon the localization of the bilateral cerebellar abnormalities found in earlier fMRI studies.MethodsWe included 21 propranolol sensitive patients, who were not using other tremor medication, with a definite diagnosis of ET defined by the Tremor Investigation Group. Simultaneous EMG-fMRI recordings were performed while patients were off tremor medication. Patients performed unilateral right hand and arm extension, inducing tremor, alternated with relaxation (rest). Twenty-one healthy, age- and sex-matched participants mimicked tremor during right arm extension. EMG power variability at the individual tremor frequency as a measure of tremor intensity variability was used as a regressor, mathematically independent of the block regressor, in the general linear model used for fMRI analysis, to find specific tremor-related activations.ResultsBlock-related activations were found in the classical upper-limb motor network, both for ET patients and healthy participants in motor, premotor and supplementary motor areas. In ET patients, we found tremor-related activations bilaterally in the cerebellum: in left lobules V, VI, VIIb and IX and in right lobules V, VI, VIIIa and b, and in the brainstem. In healthy controls we found simulated tremor-related activations in right cerebellar lobule V.ConclusionsOur results expand on previous findings of bilateral cerebellar involvement in ET. We have identified specific areas in the bilateral somatomotor regions of the cerebellum: lobules V, VI and VIII.

Age-Specific Effects of Mirror-Muscle Activity on Cross-Limb Adaptations Under Mirror and Non-Mirror Visual Feedback Conditions.

Cross-limb transfer (CLT) describes the observation of bilateral performance gains due to unilateral motor practice. Previous research has suggested that CLT may be reduced, or absent, in older adults, possibly due to age-related structural and functional brain changes. Based on research showing increases in CLT due to the provision of mirror visual feedback (MVF) during task execution in young adults, our study aimed to investigate whether MVF can facilitate CLT in older adults, who are known to be more reliant on visual feedback for accurate motor performance. Participants (N = 53) engaged in a short-term training regime (300 movements) involving a ballistic finger task using their dominant hand, while being provided with either visual feedback of their active limb, or a mirror reflection of their active limb (superimposed over the quiescent limb). Performance in both limbs was examined before, during and following the unilateral training. Furthermore, we measured corticospinal excitability (using TMS) at these time points, and assessed muscle activity bilaterally during the task via EMG; these parameters were used to investigate the mechanisms mediating and predicting CLT. Training resulted in significant bilateral performance gains that did not differ as a result of age or visual feedback (both p > 0.1). Training also elicited bilateral increases in corticospinal excitability (p < 0.05). For younger adults, CLT was significantly predicted by performance gains in the trained hand (β = 0.47), whereas for older adults it was significantly predicted by mirror activity in the untrained hand during training (β = 0.60). The present study suggests that older adults are capable of exhibiting CLT to a similar degree to younger adults. The prominent role of mirror activity in the untrained hand for CLT in older adults indicates that bilateral cortical activity during unilateral motor tasks is a compensatory mechanism. In this particular task, MVF did not facilitate the extent of CLT.

The Influence of Mirror-Visual Feedback on Training-Induced Motor Performance Gains in the Untrained Hand.

The well-documented observation of bilateral performance gains following unilateral motor training, a phenomenon known as cross-limb transfer, has important implications for rehabilitation. It has recently been shown that provision of a mirror image of the active hand during unilateral motor training has the capacity to enhance the efficacy of this phenomenon when compared to training without augmented visual feedback (i.e., watching the passive hand), possibly via action observation effects [1]. The current experiment was designed to confirm whether mirror-visual feedback (MVF) during motor training can indeed elicit greater performance gains in the untrained hand compared to more standard visual feedback (i.e., watching the active hand). Furthermore, discussing the mechanisms underlying any such MVF-induced behavioural effects, we suggest that action observation and the cross-activation hypothesis may both play important roles in eliciting cross-limb transfer. Eighty participants practiced a fast-as-possible two-ball rotation task with their dominant hand. During training, three different groups were provided with concurrent visual feedback of the active hand, inactive hand or a mirror image of the active hand with a fourth control group receiving no training. Pre- and post-training performance was measured in both hands. MVF did not increase the extent of training-induced performance changes in the untrained hand following unilateral training above and beyond those observed for other types of feedback. The data are consistent with the notion that cross-limb transfer, when combined with MVF, is mediated by cross-activation with action observation playing a less unique role than previously suggested. Further research is needed to replicate the current and previous studies to determine the clinical relevance and potential benefits of MVF for cases that, due to the severity of impairment, rely on unilateral training programmes of the unaffected limb to drive changes in the contralateral affected limb.

Motor and cognitive integration: Effect of bilateral behaviors on judgment

Performing approach vs. avoidance behaviors (arm flexion vs. arm extension) on the one hand, and lateralized peripheral activations (left side vs. right side) of the motivational systems of approach vs. avoidance, on the other hand, have been shown to impact on cognitive functioning (Cretenet, & Dru, 2009), mainly in judgment tasks. When a unilateral motor congruent behavior; that is, a behavior that activates the same motivational system (e.g., flexion of the right arm) was performed during a judgment task, participants' use of complex, interactive information integration rules was facilitated. No effect was, however, found when simpler, additive rules were involved (Mullet, Cretenet, & Dru, 2014). Three experiments are reported here that examined the effect of bilateral motor behaviors (e.g., flexion of the right arm and extension of the left arm) on the implementation of information integration rules. In Studies 1 and 2, two judgment tasks similar to the ones used by Mullet et al. (2014) were used: (a) a complex task in which participants judged a person's attractiveness from personality information, and (b) a simpler task in which they attributed blame according to bad deeds. It was found that similar motor behaviors performed by the two arms (e.g., flexion of both arms), in contrast to dissimilar ones, facilitated the use of complex, interactive information integration rules. No effect was found in the case of simpler integration rules. In Study 3, these results were replicated in a judgment task in which the complexity of the integration rule varied depending on the instructions given. Overall, when bilateral motor behaviors were performed during judgment, facilitation in the use of complex integration rules no longer depended on motivational congruence as in the case of unilateral motor behavior. It depended on symmetry/similarity of behaviors.

Effects of repetitive transcranial magnetic stimulation on arm function and decreasing unilateral spatial neglect in subacute stroke: a randomized controlled trial

Objective: The objective of this study is to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the functional recovery of stroke patients with unilateral neglect. Design: Randomized controlled experimental study. Setting: Outpatient rehabilitation hospital. Subjects: Thirty patients with stroke were randomly assigned to two groups: an rTMS group (experimental) and a control group. Interventions: Stroke patients in the experimental group underwent comprehensive rehabilitation therapy and rTMS. Stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy 5 days per week for 4 weeks. Main measures: Line bisection, Albert, Box and block and Grip strength tests were assessed before and after the four-week therapy period. Results: A significant difference in the post-training gains in Line bisection (16.53 SD 9.78 vs. 3.60 SD 5.02), Albert (14.13 SD 4.92 vs. 3.26 SD 2.01), Box and block (15.06 SD 9.68 vs. 6.93 SD 7.52), and Grip strength tests (3.60 SD 2.66 vs 0.80 SD 1.26) was observed between the experimental group and the control group (P<0.05). In addition, the effect size for gains in the experimental and control groups was very strong in AT, BBT (effect size=2.15, 0.77 respectively). Conclusion: We conclude that rTMS might be effective in improvement in reduction of the unilateral neglect and motor function.

The brain-derived neurotrophic factor Val66Met polymorphism and degeneration of the corticospinal tract after stroke: a diffusion tensor imaging study.

A common single nucleotide polymorphism, Val66Met, in the human brain-derived neurotrophic factor (BDNF) gene has a potential role in the pathogenesis and treatment of stroke. The relevance of the BDNF Val66Met polymorphism to long-term stroke outcomes was examined, specifically with respect to changes in corticospinal integrity. Thirty-five stroke patients with unilateral motor weakness were genotyped within 2 weeks after onset (T1), and changes in the integrity of the ipsilesional corticospinal tract (CST) as well as alterations in motor function at 1 month (T2) and 3 months after onset (T3) were tracked. On the basis of the Fugl-Meyer assessment upper extremity score, carriers of the Met allele (Val/Met and Met/Met) showed poorer motor outcomes at T2 and T3 compared to carriers of only the Val allele (Val/Val). For both BDNF allele types, patients exhibited characteristic degeneration of the CST compared to healthy controls. There were no differences between the two genotypes with respect to time-dependent changes in diffusion-tensor-imaging-derived parameters of the CST. However, the two groups showed different relationships between motor outcomes and directional diffusivities according to the elapsed time after onset. Poorer motor function was associated with lower axial diffusivity values for the Val/Val genotype group in the sub-acute phase (T1 and T2) but with higher radial diffusivity values for the Val/Met and Met/Met genotype group in the early chronic phase (T3). Motor recovery in stroke patients may be affected by the BDNF Val66Met polymorphism, possibly through its effects on distinct pathological processes underlying corticospinal degeneration.

Comparative gait initiation kinematics between simulated unilateral and bilateral ankle hypomobility: Does bilateral constraint improve speed performance?

Improvement of motor performance in unilateral upper limb motor disability has been shown when utilizing inter-limb coupling strategies during physical rehabilitation. This suggests that ‘default’ bilateral central motor commands are facilitated. Here, we tested whether this bilateral motor control principle may be generalized to the lower limbs during gait initiation, which involves alternate bilateral actions. Disability was simulated by strapping to produce ankle hypomobility. Healthy adult subjects initiated gait at a self-paced speed with no ankle constraint (control), or with the stance, swing or bilateral ankles strapped. The duration of the anticipatory postural adjustments lengthened and the center of mass instantaneous progression velocity at foot-off decreased when the ankle was strapped. During the step execution phase, progression velocity at foot-contact was higher when both ankles were strapped compared to unilateral strapping of the stance ankle. These findings suggest that bilateral central motor commands are favored during walking tasks. Indeed, unilateral constraint of the stance ankle should compel the central nervous system to adapt specific commands to the constraint and normal sides whereas the ‘default’ bilateral motor commands would be utilized when both ankles are strapped leading to better kinematics performance. Bilateral in-phase upper limb coordination and bilateral alternating lower limb locomotor movements may share similar control mechanisms.

Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings

To determine acute computed tomography perfusion (CTP) changes in seizure patients presenting with stroke-like symptoms and to correlate those changes with clinical presentation and electroencephalography (EEG). The medical records of all patients who presented to the emergency department with acute stroke-like symptoms and underwent CTP (n=1085) over a 5.5-year period were reviewed. Patients were included who had primary seizure as the final diagnosis, and underwent CTP within 3 hours of symptom onset. A subset of patients had a follow-up EEG within 7 days. The perfusion changes and EEG findings were compared between different clinical presentations. Eighteen of 1085 patients (1.7%) who underwent CTP following an acute stroke-like presentation were included. The abnormality on CTP was usually focal, unilateral hyperperfusion - increased relative cerebral blood flow (rCBF) and volume (rCBV) (n=14/18), which most often affected the temporal lobe. Those patients who presented with a motor or speech deficit (n=12) had a higher temporal lobe rCBV, and rCBF, and lower relative mean transit time (rMTT) compared to those with non-focal neurological deficit at presentation. Early EEG was available in 13 patients; a sharp-spike epileptiform EEG discharge pattern (n=5) was associated with higher temporal lobe ipsilateral rCBF and rCBV, and lower rMTT on admission CTP examination. Seizure patients who present with a unilateral motor or speech deficit most commonly have contralateral hyperperfusion in the corresponding eloquent brain regions on the acute-stage CTP examination. In such patients, epileptiform discharges on the early follow-up EEG are associated with ipsilateral hyperperfusion on the admission CTP.

P105. Network dynamics engaged in the modulation of motor behavior in chronic stroke patients

Background Affected hand movements are associated with a successive increase of neural activity in both hemispheres in the first weeks after stroke, which then return to levels observed in healthy controls, particularly in patients making full motor recovery. Little is known about the changes of the interplay of brain regions that enable the modulation of motor performance after stroke. In healthy subjects, an important feature of faster hand movements is mediated by a more effective coupling between distinct cortical and subcortical motor areas. But the mechanisms underlying the dynamic modulation of motor behavior in stroke patients related to motor impairment and recovery thereof are still unclear. Methods We, therefore, investigated 10 chronic stroke patients with mild to moderate unilateral hand motor deficits and 10 healthy, age-matched controls by using functional magnetic resonance imaging (fMRI). Motor system activity was assessed by fist closures at different movement frequencies (0.5 Hz, 1.0 Hz, and 2.0 Hz) performed with the affected/right or unaffected/left hand. Results When chronic stroke patients moved their affected, right hand, the fMRI data revealed a stronger frequency-dependent increase of neural activity within both the dorsolateral premotor cortex (PMd) and the superior parietal lobe (SPL), contralateral to the lesioned hemisphere as compared to healthy controls. Conclusion Our findings suggest a critical contribution of contralateral PMd and SPL in the flexible adaption of the brain to varying motor demands in chronic stroke patients controlling temporal and spatial preciseness of recovered complex hand movements in the contralesional hemisphere.

V37. Interactions between primary and secondary motor areas for recovered hand functions after stroke

Objectives Goal oriented hand movements are the final product of complex interplay between multiple cortical regions of the frontoparietal cortex. Following stroke, recovery of function might be related to structural and functional modifications in the surviving brain networks. Strikingly, the ventral premotor cortex (PMv) plays a crucial role in the sensorimotor processing engaged in shaping finger movements and shares extensive reciprocal projections to the primary motor cortex (M1), making the PMv a promising structure involved in hand motor recovery after stroke. By instance, mapping studies in stroke animal models consistently showed that improvement in forelimb motor performance was associated with reorganization within the PMv. However, precise functional interactions between the PMv and the M1 in the process of hand motor recovery have not been investigated in stroke patients. Paired-pulse transcranial magnetic stimulation (pp-TMS) was used in order to evaluate PMv-M1 interactions in stroke patients and healthy controls. To further disentangle whether recovery-related changes are specific to PMv-M1 or apparent in all interactions between primary and secondary motor areas after stroke, connectivity between posterior parietal cortex (PPC) and M1 have been also assessed. Methods 22 patients (aged 62.3 ± 9.8 SD) with mild to severe unilateral hand motor deficit and 20 healthy controls (aged 59.7 ± 20.9 SD) participated in the present study. Within experiment-1, PMv-M1 interactions were investigated by using neuronavigated-ppTMS in both the affected and unaffected hemisphere, considering 6 interstimulus intervals (ISI; 2, 4, 6, 8, 10 and 15 ms) between conditioning and test pulse. In experiment-2, PPC-M1 interactions were investigated targeting two PPC regions: the anterior intraparietal sulcus (aIPS) and the caudal intraparietal sulcus (cIPS). Results Experiment-1: A consistent difference between patients and controls, with a group by ISI interaction, has been observed for both the affected (F = 14.9, p Conclusions The present pp-TMS approach enabled us to assess in vivo the specific contributions of individual brain areas to recovery of function after stroke. These findings demonstrate changes in interareal connectivity between the PMv and the M1 associated with recovered hand motor function. These data support a paramount role of the PMv within the process of functional reorganization and successful hand motor recovery, as suggested in previous animal work, contributing significantly to the understanding of the mechanisms underlying cortical reorganization after focal brain lesions.

Acute lower motor neuron syndrome and spinal cord gray matter hyperintensities in HIV infection.

Objective:To describe a novel manifestation of lower motor neuron disease in patients with well-controlled HIV infection.Methods:A retrospective study was performed to identify HIV-positive individuals with acute, painful lower motor neuron diseases.Results:Six patients were identified with HIV and lower motor neuron disease. Two patients met the inclusion criteria of well-controlled, chronic HIV infection and an acute, painful, unilateral lower motor neuron paralytic syndrome affecting the distal portion of the upper limb. These patients had segmental T2-hyperintense lesions in the central gray matter of the cervical spinal cord on MRI. One patient stabilized and the second patient improved with immunomodulatory therapy.Conclusions:This newly described syndrome expands the clinical spectrum of lower motor neuron diseases in HIV.

Intermanual transfer and bilateral cortical plasticity is maintained in older adults after skilled motor training with simple and complex tasks.

Intermanual transfer refers to the phenomenon whereby unilateral motor training induces performance gains in both the trained limb and in the opposite, untrained limb. Evidence indicates that intermanual transfer is attenuated in older adults following training on a simple ballistic movement task, but not after training on a complex task. This study investigated whether differences in plasticity in bilateral motor cortices underlie these differential intermanual transfer effects in older adults. Twenty young (<35 years-old) and older adults (>65 years) trained on a simple (repeated ballistic thumb abduction) and complex (sequential finger-thumb opposition) task in separate sessions. Behavioral performance was used to quantify intermanual transfer between the dominant (trained) and non-dominant (untrained) hands. The amplitude of motor-evoked potentials induced by single pulse transcranial magnetic stimulation was used to investigate excitability changes in bilateral motor cortices. Contrary to predictions, both age groups exhibited performance improvements in both hands after unilateral skilled motor training with simple and complex tasks. These performance gains were accompanied by bilateral increases in cortical excitability in both groups for the simple but not the complex task. The findings suggest that advancing age does not necessarily influence the capacity for intermanual transfer after training with the dominant hand.