Article
Cortical plasticity of motor and somatosensory areas in degenerative cervical myelopathy
Kortikale Plastizität motorischer und somatosensorischer Areale in degenerativer zervikaler Myelopathie
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Authors
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Charlotte Nettekoven
- Universitätsklinikum Köln, Department of General Neurosurgery, Köln, Deutschland
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Leonie Hams
- Universitätsklinikum Köln, Department of General Neurosurgery, Köln, Deutschland
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Thorsten Lichtenstein
- Universitätsklinikum Köln, Institute for Diagnostic and Interventional Radiology, Köln, Deutschland
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Anna Zdunczyk
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Roland Goldbrunner
- Universitätsklinikum Köln, Department of General Neurosurgery, Köln, Deutschland
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Carolin Weiß-Lucas
- Universitätsklinikum Köln, Department of General Neurosurgery, Köln, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Surgical decision making in Degenerative Cervical Myelopathy (DCM) is often challenging due to the lack of sufficiently reliable predictors of disease progression and surgical outcome. Recently, the compensatory potential of reorganization processes within the cerebrospinal motor network as assessed by transcranial magnetic stimulation (TMS) has been discussed as a novel prognostic factor. However, the possible involvement of non-primary motor areas remains unclear. Moreover, somatosensory impairment as an early but often overlooked symptom of DCM was not in the main focus of research so far. We, therefore, used functional MRI (fMRI) to investigate the adaptive functional changes of primary and non-primary motor areas as well as somatosensory cortices in DCM.
Methods: 10 right-handed DCM patients (56±12 yrs, m=7, mean JOA score 13.3±2.3) and 10 age- and gender-matched healthy controls (57±12 yrs, m=7) underwent a fMRI (3T) session. The fMRI procedure consisted of alternating movements of the left and right hand and foot as well as passive somatosensory stimulation of the subjects’ hands and feet. fMRI data were analyzed using MATLAB® 2019a and the SPM12 software package. Hand motor areas were assessed using TMS in a separate session.
Results: Similar to previous results reported for the TMS hand motor area, a tendency towards higher BOLD activity was found for the representation of the left and right foot area in DCM patients (p≤0.1, uncorr.). Moreover, non-primary motor areas like the dorsal premotor cortex also showed stronger BOLD activity as compared to healthy subjects (p≤0.1, uncorr.). In contrast to the motor task, the sensory stimulation led to a weaker activation of the hand area within the left (dominant) hemisphere in patients (p≤0.001, uncorr.). Regarding the other task conditions, patients showed only weak activation in S1 (p≤0.001, uncorr.) and a much scarcer involvement of ipsilateral areas than controls.
Conclusion: Our results suggest that DCM leads not only to cortical plasticity in primary motor areas of the hand and foot, but also to the compensatory recruitment of non-primary motor areas. In contrast to the motor representation, cortical responsiveness to sensory stimuli was reduced in DCM. Beyond the question of post-surgical reversibility, it remains to be investigated to which extent the BOLD activity alterations translate to the degree of clinical affection and to the changes of cortical excitability measured by TMS.
