形状记忆合金*
辅助电机区
医学
运动前皮质
运动皮层
额叶
神经科学
初级运动皮层
癫痫
物理医学与康复
刺激
心理学
功能磁共振成像
解剖
放射科
内科学
背
组合数学
数学
作者
Jennifer Hong,Robert J. Quon,Yinchen Song,Tiankang Xie,Joshua J Levy,Erin D'Agostino,Edward V. Camp,David W Roberts,Barbara C Jobst
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2022-10-18
卷期号:92 (1): 186-194
标识
DOI:10.1227/neu.0000000000002172
摘要
Direct cortical stimulation of the mesial frontal premotor cortex, including the supplementary motor area (SMA), is challenging in humans. Limited access to these brain regions impedes understanding of human premotor cortex functional organization and somatotopy.To test whether seizure onset within the SMA was associated with functional remapping of mesial frontal premotor areas in a cohort of patients with epilepsy who underwent awake brain mapping after implantation of interhemispheric subdural electrodes.Stimulation trials from 646 interhemispheric subdural electrodes were analyzed and compared between patients who had seizure onset in the SMA (n = 13) vs patients who had seizure onset outside of the SMA (n = 12). 1:1 matching with replacement between SMA and non-SMA data sets was used to ensure similar spatial distribution of electrodes. Centroids and 95% confidence regions were computed for clustered head, trunk, upper extremity, lower extremity, and vision responses. A generalized linear mixed-effects model was used to test for significant differences in the resulting functional maps. Clinical, radiographic, and histopathologic data were reviewed.After analyzing direct cortical stimulation trials from interhemispheric electrodes, we found significant displacement of the head and trunk responses in SMA compared with non-SMA patients ( P < .01 for both). These differences remained significant after accounting for structural lesions, preexisting motor deficits, and seizure outcome.The somatotopy of the mesial frontal premotor regions is significantly altered in patients who have SMA-onset seizures compared with patients who have seizure onset outside of the SMA, suggesting that functional remapping can occur in these brain regions.
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