Functional anatomy of the human supplementary sensorimotor area: results of extraoperative electrical stimulation

Encoding of speed and direction of movement in the human supplementary motor area

OBJECT

The supplementary motor area (SMA) plays an important role in planning, initiation, and execution of motor acts. Patients with SMA lesions are impaired in various kinematic parameters, such as velocity and duration of movement. However, the relationships between neuronal activity and these parameters in the human brain have not been fully characterized. This is a study of single-neuron activity during a continuous volitional motor task, with the goal of clarifying these relationships for SMA neurons and other frontal lobe regions in humans.

METHODS

The participants were 7 patients undergoing evaluation for epilepsy surgery requiring implantation of intracranial depth electrodes. Single-unit recordings were conducted while the patients played a computer game involving movement of a cursor in a simple maze.

RESULTS

In the SMA proper, most of the recorded units exhibited a monotonic relationship between the unit firing rate and hand motion speed. The vast majority of SMA proper units with this property showed an inverse relation, that is, firing rate decrease with speed increase. In addition, most of the SMA proper units were selective to the direction of hand motion. These relationships were far less frequent in the pre-SMA, anterior cingulate gyrus, and orbitofrontal cortex.

CONCLUSIONS

The findings suggest that the SMA proper takes part in the control of kinematic parameters of endeffector motion, and thus lend support to the idea of connecting neuroprosthetic devices to the human SMA.

Moderate variability in stimulus presentation improves motor response control

To examine the impact of interstimulus "jitter" (i.e., randomization of the interval between successive stimulus events) on response control during continuous task performance, 41 healthy adults completed four go/no-go tasks that were identical except for interstimulus interval (ISI) jitter: a 0% jitter task with a fixed (1,000-ms) ISI, a 10% jitter task with an ISI range of 900-1,100 ms, a 30% jitter task with an ISI range of 700-1,300 ms, and a 50% jitter task with an ISI range of 500-1,500 ms. Repeated measures analysis of variance (ANOVA) revealed a quadratic effect of jitter on commissions across the group and on intrasubject reaction time variability in men; in both cases, performance was best for the 10% jitter condition. A linear effect of jitter was observed for reaction time (RT) with high levels of jitter (50%) resulting in longer RT. Findings suggest that response selection, including inhibition, is optimized by moderate increases in ISI jitter. More deliberate and controlled responding observed with increasing jitter may have important treatment implications for disorders (e.g., attention-deficit/hyperactivity disorder, ADHD), associated with impaired response control.

Somatosensory, motor, and reaching/grasping responses to direct electrical stimulation of the human cingulate motor areas

Object

Surgery for frontal lobe drug-resistant epilepsies is often limited by the apparent widespread distribution of the epileptogenic zone. Recent advances in the parcellation of the medial premotor cortex give the opportunity to reconsider “seizures of the supplementary motor area” (SMA), and to assess the contribution of cingulate motor areas (CMAs), SMA proper (SMAp), and pre-SMA to the symptomatology of premotor seizures.

Methods

The authors reviewed the results of extraoperative electrical stimulation (ES) applied in 52 candidates for epilepsy surgery who underwent stereotactic intracerebral electroencephalographic recordings, focusing on ES of the different medial premotor fields; that is, the anterior and posterior CMA, the SMAp, and the pre-SMA. The ES sites were localized by superposition of the postoperative lateral skull x-ray and the preoperative sagittal MR imaging studies.

Results

Among 94 electrodes reaching the medial premotor wall, 57 responses were obtained from the anterior CMA (13 cases), the posterior CMA (11), the pre-SMA (18), and the SMAp (15). The ES of the pre-SMA and SMAp gave rise most often to a combination of motor (31 cases), speech-related (22), or somatosensory (3) elementary symptoms. The ES of the CMA yielded simple (17 of 24) more often than complex responses (7 of 24), among which sensory symptoms (7) were overrepresented. Irrepressible exploratory reaching/grasping movements were elicited at the vicinity of the cingulate sulcus, from the anterior CMA (3 cases) or the pre-SMA (1). Clinical responses to ES were not predictive of the postoperative neurological outcome.

Conclusions

These findings might be helpful in epilepsy surgery candidates, to better target investigation of the CMA, pre-SMA, and SMAp, and therefore to provide a better understanding of premotor seizures.

Extraoperative functional mapping of motor areas in epileptic patients by high-frequency cortical stimulation

Object

The aim of this study was to investigate the usefulness of a short train of high-frequency (500 Hz) cortical stimulation to delineate the primary motor cortex (MI), supplementary motor area (SMA), primary somatosensory cortex (SI), supplementary sensory area (SSA), negative motor area (NMA), and supplementary negative motor area (SNMA) in patients with epilepsy who were undergoing functional mapping.

Methods

Seventeen patients were studied, all of whom underwent functional mapping using 50-Hz electrical stimulation. After these clinical evaluations, cortical stimulations with a short train of electrical pulses at 500 Hz were performed through subdural electrodes placed at the MI, SMA, SI, SSA, NMA, and SNMA, which had been identified by 50-Hz stimulation, and surrounding cortical areas, while surface electromyography readings were recorded.

Results

Stimulation of the MI elicited motor evoked potentials (MEPs) in contralateral muscles. Stimulation of the SMA also induced MEPs in contralateral muscles but with longer latencies compared with the MI stimulation. Stimulation of the SMA did not elicit MEPs in ipsilateral muscles. Stimulation of the SI, SSA, NMA, and SNMA did not induce MEPs in any muscle. In one patient, MEPs were elicited without seizure induction by 500-Hz stimulation of the electrodes, whereas a 50-Hz stimulation of the same electrodes induced his habitual seizures.

Conclusions

Extraoperative high-frequency stimulation with MEP monitoring is a useful complementary method for cortical mapping without inducing seizure. Stimulation of SMA induces MEPs in contralateral muscles, with longer latencies compared with the stimulation of MI. This finding may be useful for the differentiation between MI and SMA, especially in the foot motor areas.

Response inhibition and response selection: two sides of the same coin

Response inhibition refers to the suppression of actions that are inappropriate in a given context and that interfere with goal-driven behavior. Studies using a range of methodological approaches have implicated executive control processes mediated by frontal-subcortical circuits as being critical to response inhibition; however, localization within the frontal lobe has been inconsistent. In this review, we present evidence from behavioral, lesion, neuroimaging, electrophysiology, and neurological population studies. The findings lay the foundation for a construct in which response inhibition is akin to response selection, such that pre-SMA circuits are critical to selection of appropriate behavior, including both selecting to engage appropriate motor responses and selecting to withhold (inhibit) inappropriate motor responses. Recruitment of additional prefrontal and posterior cortical circuits, necessary to guide response selection, varies depending on the cognitive and behavioral demands of the task.

Whole-hand sensorimotor area: cortical stimulation localization and correlation with functional magnetic resonance imaging

OBJECT

The pli de passage moyen (PPM) is an omega-shaped cortical landmark bulging into the central sulcus. There has been considerable interest in the PPM given that hand motor and sensory tasks have been found on functional magnetic resonance (fMR) imaging to activate the structure. Note, however, that the cortical function subserved by the PPM is not completely understood. Finger and thumb function are somatotopically organized over the central area and encompass a larger cortical surface than the anatomical PPM. Therefore, a sensory or motor hand area within the PPM would be redundant with the somatotopically organized digit function in the primary sensorimotor cortex. In this study the authors aimed to clarify the function subserved by the PPM and further evaluate hand area function in the primary sensorimotor cortex.

METHODS

To further elucidate the function subserved by the PPM, patients underwent cortical stimulation in the region of the PPM as well as fMR imaging-demonstrated activation of the hand area. Two separate analytical methods were used to correlate hand area functional imaging with whole-hand sensory and motor responses induced by cortical stimulation.

RESULTS

A relationship of the anatomical PPM with cortical stimulation responses as well as hand fMR imaging activation was observed.

CONCLUSIONS

A strong relationship was identified between the PPM, whole-hand sensory and motor stimulation responses, and fMR imaging hand activation. Whole-hand motor and whole-hand sensory cortical regions were identified in the primary sensorimotor cortex. It was localized to the PPM and exists in addition to the somatotopically organized finger and thumb sensory and motor areas.

Probabilistic maps, morphometry, and variability of cytoarchitectonic areas in the human superior parietal cortex

Recently, 8 areas (5Ci, 5M, 5L, 7PC, 7A, 7P, 7M, hIP3) in the human superior parietal cortex (SPC) were delineated in 10 postmortem brains using observer-independent cytoarchitectonic analysis. Here we present 3D probabilistic maps of these areas, quantifying the interindividual overlap for each voxel in stereotaxic reference space, and a maximum probability map, providing a contiguous parcellation. For all areas, we determined probabilities of mutual borders, calculated stereotaxic centers of gravity, and estimated volumes. A basic pattern of areas and borders was observed, which showed, however, intersubject variations and a significant interhemispheric asymmetry (7P, 7M) that may be functionally relevant. There was a trend toward higher intersubject anatomical variability in lateral compared with medial areas. For several areas (5M, 7PC, 7A, 7P), variability was significantly higher in the left hemisphere and/or in men, whereas for areas 5Ci and 5M there was a hemisphere-by-gender interaction. Differences in anatomical variability could bias group analyses in functional imaging studies by reducing sensitivity for activations of entities with high variability. The probabilistic maps provide an objective anatomical reference and account for the structural variability of the human brain. Integrated into functional imaging experiments, they can improve structure-function investigations of the human SPC.

Update on epilepsy and cerebral localization

The field of epilepsy has contributed significantly to localization of neurologic function, particularly in the neocortex. Methodologies such as cortical stimulation, positron emission tomography, functional MRI, trans-cranial magnetic stimulation, surgical resection, and magnetoencephalography have been used successfully in patients with epilepsy to locate specific functions, primarily for the purpose of defining eloquent cortex before surgical resections. The left hemisphere serves language-related functions and verbal memory in most people, whereas the right hemisphere serves some language function in addition to perceiving most components of music and other forms of nonverbal material. Both hemispheres cooperate in understanding spatial relationships. Studies in patients with developmental abnormalities have enriched our understanding of localization of function within the cortex. Future studies may help us understand the sequence in which specific regions are activated during specific tasks and determine which regions are necessary for tasks and which are supplementary. The ability to predict preoperatively the effect of removal of specific tissues would benefit surgical planning for all patients who undergo cortical resections, including those with epilepsy.

Golf putt outcomes are predicted by sensorimotor cerebral EEG rhythms

It is not known whether frontal cerebral rhythms of the two hemispheres are implicated in fine motor control and balance. To address this issue, electroencephalographic (EEG) and stabilometric recordings were simultaneously performed in 12 right-handed expert golfers. The subjects were asked to stand upright on a stabilometric force platform placed at a golf green simulator while playing about 100 golf putts. Balance during the putts was indexed by body sway area. Cortical activity was indexed by the power reduction in spatially enhanced alpha (8-12 Hz) and beta (13-30 Hz) rhythms during movement, referred to as the pre-movement period. It was found that the body sway area displayed similar values in the successful and unsuccessful putts. In contrast, the high-frequency alpha power (about 10-12 Hz) was smaller in amplitude in the successful than in the unsuccessful putts over the frontal midline and the arm and hand region of the right primary sensorimotor area; the stronger the reduction of the alpha power, the smaller the error of the unsuccessful putts (i.e. distance from the hole). These results indicate that high-frequency alpha rhythms over associative, premotor and non-dominant primary sensorimotor areas subserve motor control and are predictive of the golfer's performance.

Human MST but not MT responds to tactile stimulation

Previous reports of tactile responses in human visual area MT/V5 have used complex stimuli, such as a brush stroking the arm. These complex moving stimuli are likely to induce imagery of visual motion, which is known to be a powerful activator of MT. The area described as "MT" in previous reports consists of at least two distinct cortical areas, MT and MST. Using functional magnetic resonance imaging, we separately localized human MT and MST and measured their response to vibrotactile stimuli unlikely to induce imagery of visual motion. Strong vibrotactile responses were observed in MST but not in MT. Vibrotactile responses in MST were approximately one-half as large as the response to visual motion and were distinct from those in another visual area previously reported to respond to tactile stimulation, the lateral occipital complex. To examine somatotopic organization, we separately stimulated the left and right hand and foot. No spatial segregation between hand and foot responses was observed in MST. The average response profile of MST was similar to that of somatosensory cortex, with a strong preference for the contralateral hand. These results offer evidence for the existence of somatosensory responses in MST, but not MT, independent of imagery of visual motion.

Observer-independent cytoarchitectonic mapping of the human superior parietal cortex

The human superior parietal cortex (SPC; Brodmann areas [BA] 5 and 7) comprises the superior parietal lobule and medial wall of the intraparietal sulcus (mIPS) laterally and the posterior paracentral lobule and precuneus medially. Receptor autoradiographic and functional studies indicate more complex segregations in the SPC than suggested by Brodmann (1909). Differences to other historical maps may be due to anatomical variability between brains and different definition criteria for areas. To provide a reliable anatomical reference of the SPC, we performed an observer-independent cytoarchitectonic mapping of this region in 10 human postmortem brains. Cytoarchitecture was analyzed in cell-body-stained brain sections using gray-level index profiles. Multivariate statistical analysis of profile shape allowed the exact localization of cytoarchitectonic borders and quantification of interareal differences. We identified 3 areas in BA 5 (5L, 5M, and 5Ci), 4 in BA 7 (7PC, 7A, 7P, and 7M), and 1 in the anterior mIPS (hIP3). Locations of their borders relative to macroanatomical landmarks varied considerably between brains and hemispheres. Cytoarchitectonic profiles of areas 5Ci and hIP3 differed most from those of the remaining areas, and differences between subareas were stronger in BA 5 than in BA 7. These areas are possible structural correlates of functional segregations within the SPC.

Towards a functional topography of sensory gating areas: invasive P50 recording and electrical stimulation mapping in epilepsy surgery candidates

The filtering of sensory information, also referred to as "sensory gating", is impaired in various neuropsychiatric diseases. In the auditory domain, sensory gating is investigated mainly as a response decrease of the auditory evoked potential component P50 from one click to the second in a double-click paradigm. In order to relate deficient sensory gating to anatomy, it is essential to identify the cortical structures involved in the generation of P50. However, the exact cerebral topography of P50 gating remains largely unknown. In a group of 17 patients with drug-resistant focal epilepsy, P50 was recorded invasively via subdural electrodes, and the topography of functionally indispensable ("eloquent") cortices was obtained by electrical stimulation mapping. These eloquent areas were involved in language, motor, and sensory functions. P50 could be identified in 13 patients in either temporal (n=8) or midfrontal sites (n=5). There were six occurrences (in five patients) of overlap of sites with maximal P50 responses and eloquent areas. Those were auditory (n=1), supplementary sensorimotor (n=3), primary motor (n=1), and supplementary negative motor (n=1). Results suggest that the early stage of sensory gating already involves a top-down modulation of sensory input by frontal areas.

Human limb-specific and non-limb-specific brain representations during kinesthetic illusory movements of the upper and lower extremities

Sensing movements of the upper and lower extremities is important in controlling whole-body movements. We have shown that kinesthetic illusory hand movements activate motor areas and right-sided fronto-parietal cortices. We investigated whether illusions for the upper and lower extremities, i.e. right or left hand or foot, activate the somatotopical sections of motor areas, and if an illusion for each limb engages the right-sided cortices. We scanned the brain activity of 19 blindfolded right-handed participants using functional magnetic resonance imaging (fMRI) while they experienced an illusion for each limb elicited by vibrating its tendon at 110 Hz (ILLUSION). As a control, we applied identical stimuli to the skin over a nearby bone, which does not elicit illusions (VIBRATION). The illusory movement (ILLUSION vs. VIBRATION) of each immobile limb activated limb-specific sections of the contralateral motor cortex (along with somatosensory area 3a), dorsal premotor cortex (PMD), supplementary motor area (SMA), cingulate motor area (CMA), and the ipsilateral cerebellum, which normally participate in execution of movements of the corresponding limb. We found complex non-limb-specific representations in rostral parts of the bilateral SMA and CMA, and illusions for all limbs consistently engaged concentrated regions in right-sided fronto-parietal cortices and basal ganglia. This study demonstrated complete sets of brain representations related to kinesthetic processing of single-joint movements of the four human extremities. The kinesthetic function of motor areas suggests their importance in somatic perception of limb movement, and the non-limb-specific representations indicate high-order kinesthetic processing related to human somatic perception of one's own body.

Amplitude of low frequency fluctuation within visual areas revealed by resting-state functional MRI

Most studies of resting-state functional magnetic resonance imaging (fMRI) have applied the temporal correlation in the time courses to investigate the functional connectivity between brain regions. Alternatively, the power of low frequency fluctuation (LFF) may also be used as a biomarker to assess spontaneous activity. The purpose of the current study is to evaluate whether the amplitude of the LFF (ALFF) relates to cerebral physiological states. Ten healthy subjects underwent four resting-state fMRI scanning sessions, two for eyes-open (EO) and two for eyes-closed (EC) conditions, with two sets of parameters (TR=400 ms and 2 s, respectively). After data preprocessing, ALFF was obtained by calculating the square root of the power spectrum in the frequency range of 0.01-0.08 Hz. Our results showed that the ALFF in EO was significantly higher than that in EC (P<0.05, corrected) in the bilateral visual cortices. Furthermore, the ALFF in EO was significantly reduced in the right paracentral lobule (PCL) than in EC (P<0.05, corrected). Region of interest (ROI) analysis showed that the ALFF differences between EO and EC were consistent for each subject. In contrast, no significant ALFF differences were found between EO and EC (P<0.381) in the posterior cingulate cortex. All these results agree well with previous studies comparing EO and EC states. Our finding of the distinct ALFF difference between EO and EC in the visual cortex implies that the ALFF may be a novel biomarker for physiological states of the brain.

Cortical control of muscle relaxation: A lateralized readiness potential (LRP) investigation

OBJECTIVE

We used the lateralized readiness potential (LRP) to investigate cortical mechanisms underlying the termination of muscle contraction. Active suppression and withdrawal of activation have been proposed as underlying mechanisms in isotonic and isometric relaxation.

METHODS

Experiment 1 investigated isotonic wrist extension/release from extension. Experiment 2 investigated isometric activation/relaxation of a pinch grip. Tasks were performed with left and right hands and cued auditorily at variable intervals. EEG was recorded from 128 electrodes and processed to derive the LRP timelocked to the onset and offset of muscle contraction.

RESULTS

LRPs for isotonic activation and relaxation were of identical amplitude at electrodes overlying the motor cortex, but differed at frontal locations due to higher amplitude re-afferent activity during activation. The isometric LRP was significantly smaller during relaxation than during activation, without differences in scalp distribution.

CONCLUSION

The LRP findings confirm differences between isotonic and isometric relaxation, which may be partly explained by the need to suppress a stretch reflex in the former condition. The presence of an LRP associated with isometric relaxation reveals active preparation in the motor cortex, indicating that muscle relaxation in the isometric task cannot be explained solely by withdrawal of activation.

SIGNIFICANCE

High-density LRP recordings isolate different cortical mechanisms underlying the termination of muscle contraction.

REVIEW ARTICLE: Cortical control of eye and head movements: integration of movements and percepts

The cortical control of eye movements is well known. It remains unclear, however, as to how the eye fields of the frontal lobes generate and coordinate eye and head movements. Here, we review the recent advances in electrical stimulation studies and evaluate relevant models. As electrical stimulation is conducted in head-unrestrained, behaving subjects with the evoked eye and head movements sometimes being indistinguishable from natural gaze shifts, a pertinent question becomes whether these movements are evoked by motor programs or sensory percepts. Recent stimulation studies in the visual cortex and the eye fields of the frontal lobes have begun to bring both possibilities to light. In addition, cognitive variables often interact with behavioral states that can affect movements evoked by stimulation. Identifying and controlling these variables are critical to our understanding of experimental results based on electrically evoked movements. This understanding is needed before one can draw inferences from such results to elucidate the neural mechanisms underlying natural and complex movements.

Comparison between motor evoked potential recording and fiber tracking for estimating pyramidal tracts near brain tumors

OBJECT

The utility of subcortical electrical stimulation and fiber tracking were compared to estimate the pyramidal tract near brain tumors.

METHODS

In 22 patients, the white matter at the bottom of a tumor was electrically stimulated near the fiber tracking of the pyramidal tract shown on a neuronavigation system. The distance between the center of the fiber tracking of these tracts and the stimulated region was measured and defined as the motor evoked potential (MEP) response. The MEP was consistently produced at distances less than 7 mm (six patients), but was consistently absent at distances more than 13 mm (seven patients) from the fiber tracking of the pyramidal tracts. In the nine patients in whom the distance was between 8 and 12 mm, an MEP was elicited when stimulation was applied at the level of the corona radiata. Motor function was preserved or even improved with appropriate tumor resection in all patients.

CONCLUSIONS

The anteroposteriorly running superior longitudinal fasciculus could cause complications in the fiber tracking of upper-extremity motor pathways at the level of the corona radiata. During resection of tumors located near the corona radiata, subcortical electrical stimulation should be applied at some distance from the pyramidal tract, as estimated by fiber tracking.

Negative myoclonus. An overview of its clinical features, pathophysiological mechanisms, and management

Negative myoclonus (NM) is an unspecific motor disorder that can characterize a variety of neurological conditions. From the clinical point of view, NM appears as a shock-like involuntary jerky movement caused by a sudden, brief interruption of muscle activity. Asterixis is a type of NM that occurs typically in toxic-metabolic encephalopathies. NM of epileptic nature, or epileptic negative myoclonus (ENM), is defined as an interruption of tonic muscle activity, which is time-locked to an epileptic EEG abnormality, without evidence of an antecedent positive myoclonia in the agonist-antagonist muscles. ENM can be observed in idiopathic, cryptogenic, and symptomatic epileptic disorders. Pathophysiological hypotheses on the origin of NM involve subcortical as well as cortical mechanisms. Recent neuroimaging and neurophysiologic investigations, including intracerebral recordings and electrical stimulation procedures in epileptic patients, suggest the participation of premotor, primary motor, primary sensory, and supplementary motor areas in the genesis of NM. Polygraphic monitoring is essential for the diagnosis of NM, allowing the demonstration of brief interruptions of a tonic EMG activity, not preceded by a positive myoclonus in the agonist and antagonist muscles of the affected limb. Simultaneous EEG-EMG monitoring demonstrating the association of NM with an epileptic potential is consistent with the diagnosis of ENM. Evolution and prognosis of NM is mainly related to aetiology. In childhood idiopathic partial epilepsy, ENM can respond to some drugs (in particular, ethosuximide), whereas other medications (such as carbamazepine or phenytoin) have been reported to induce or worsen it.

Event-related beta EEG-changes during passive and attempted foot movements in paraplegic patients

A number of electroencephalographic (EEG) studies report on motor event-related desynchronization and synchronization (ERD/ERS) in the beta band, i.e. a decrease and increase of spectral amplitudes of central beta rhythms in the range from 13 to 35 Hz. Following an ERD that occurs shortly before and during the movement, bursts of beta oscillations (beta ERS) appear within a 1-s interval after movement offset. Such a post-movement beta ERS has been reported after voluntary hand movements, passive movements, movement imagination, and also after movements induced by functional electrical stimulation. The present study compares ERD/ERS patterns in paraplegic patients (suffering from a complete spinal cord injury) and healthy subjects during attempted (active) and passive foot movements. The aim of this work is to address the question, whether patients do have the same focal beta ERD/ERS pattern during attempted foot movement as healthy subjects do. The results showed midcentral-focused beta ERD/ERS patterns during passive, active, and imagined foot movements in healthy subjects. This is in contrast to a diffuse and broad distributed ERD/ERS pattern during attempted foot movements in patients. Only one patient showed a similar ERD/ERS pattern. Furthermore, no significant ERD/ERS patterns during passive foot movement in the group of the paraplegics could be found.

Unilateral epileptic negative myoclonus following focal lesion of the postcentral cerebral cortex due to acute middle cerebral infarction

Here we report a patient who suffered an acute infarction of the contralateral postcentral cerebral cortex and subsequently developed unilateral partial epilepsy with negative myoclonus. The findings of brain magnetic resonance imaging, polygraphic recordings of the postcentral somatosensory area, and response to anticonvulsant treatment support the presence of a cause-and-effect relationship, thereby providing evidence for a pathophysiological substrate for epileptic negative myoclonus.

Evidence for early activation of primary motor cortex and SMA after electrical lower limb stimulation using EEG source reconstruction

Compared to median nerve somatosensory evoked potentials (SEP), less is known about activity evoked by nerve stimulation of the lower limb. To understand the mechanisms and the physiology of sensor- and motor control it is useful to investigate the sensorimotor functions as revealed by a standardized functional status. Therefore, we investigated SEPs of the lower limb in 6 healthy male volunteers. For each side, tibial and peroneal nerves were stimulated transcutaneously at the fossa poplitea. The tibial nerves were also stimulated further distally at the ankle joint. Source localization was applied to 64-EEG-channel data of the SEPs. In contrast to somatosensory areas, which are activated after median nerve stimulation, we found dipoles adjacent to motor areas near Brodmann area 4 (BA 4) for SEP components P 32/40 and P 54/60 and near the supplementary motor area (SMA) for the N 75/83 component. These sources could reliably be distinguished for each individual subject as well as for the grand mean data set. Our data show that afferent projections from the lower limb mainly reach primary motor areas (BA 4) and only subsequently, with a delay of 40 ms, higher order motor areas such as SMA. We conclude that a focused view on SEP of the lower limb could be a useful tool to investigate pathological states in motor control or peripheral deafferentiation.

Somatotopy of anterior cingulate cortex (ACC) and supplementary motor area (SMA) for electric stimulation of the median and tibial nerves: an fMRI study

In this study, we tested whether there is a somatotopic sensory organization in human anterior cingulate cortex (ACC) and supplementary motor area (SMA), as a reflection of central feed-back sensory processing for motor control. To this aim, fMRI recordings were performed in 15 normal young adults during nonpainful and painful electric stimulation of median nerve at the wrist and tibial nerve at the medial malleolus. Results showed that the representation of median nerve area was more anterior in the ACC and more inferior in the SMA than the one of tibial nerve area. This was true for both nonpainful and painful stimulation intensities. These results point to a somatotopic sensory organization of human ACC and SMA.

What is the Bereitschaftspotential?

Since discovery of the slow negative electroencephalographic (EEG) activity preceding self-initiated movement by Kornhuber and Deecke [Kornhuber HH, Deecke L. Hirnpotentialänderungen bei Willkurbewegungen und passiven Bewegungen des Menschen: Bereitschaftspotential und reafferente Potentiale. Pflugers Archiv 1965;284:1-17], various source localization techniques in normal subjects and epicortical recording in epilepsy patients have disclosed the generator mechanisms of each identifiable component of movement-related cortical potentials (MRCPs) to some extent. The initial slow segment of BP, called 'early BP' in this article, begins about 2 s before the movement onset in the pre-supplementary motor area (pre-SMA) with no site-specificity and in the SMA proper according to the somatotopic organization, and shortly thereafter in the lateral premotor cortex bilaterally with relatively clear somatotopy. About 400 ms before the movement onset, the steeper negative slope, called 'late BP' in this article (also referred to as NS'), occurs in the contralateral primary motor cortex (M1) and lateral premotor cortex with precise somatotopy. These two phases of BP are differentially influenced by various factors, especially by complexity of the movement which enhances only the late BP. Event-related desynchronization (ERD) of beta frequency EEG band before self-initiated movements shows a different temporospatial pattern from that of the BP, suggesting different neuronal mechanisms for the two. BP has been applied for investigating pathophysiology of various movement disorders. Volitional motor inhibition or muscle relaxation is preceded by BP quite similar to that preceding voluntary muscle contraction. Since BP of typical waveforms and temporospatial pattern does not occur before organic involuntary movements, BP is used for detecting the participation of the 'voluntary motor system' in the generation of apparently involuntary movements in patients with psychogenic movement disorders. In view of Libet et al.'s report [Libet B, Gleason CA, Wright EW, Pearl DK. Time of conscious intention to act in relation to onset of cerebral activity (readiness-potential). The unconscious initiation of a freely voluntary act. Brain 1983;106:623-642] that the awareness of intention to move occurred much later than the onset of BP, the early BP might reflect, physiologically, slowly increasing cortical excitability and, behaviorally, subconscious readiness for the forthcoming movement. Whether the late BP reflects conscious preparation for intended movement or not remains to be clarified.

Executive control of countermanding saccades by the supplementary eye field

The supplementary eye field registers the occurrence of conflict, errors and reward in macaque monkeys performing a saccade-countermanding task. Using intracortical microstimulation, we determined whether the supplementary eye field only monitors or can actually influence performance. Weak microstimulation of many sites in the supplementary eye field improved monkeys' performance on a 'stop signal' task by delaying saccade initiation. This effect depended on the context of the task because simple visually guided saccades were not delayed by the same stimulation. These results demonstrate that the supplementary eye field can exert contextual executive control over saccade generation.

New concepts in surgery of WHO grade II gliomas: functional brain mapping, connectionism and plasticity – a review

Despite a recent literature supporting the impact of surgery on the natural history of low-grade glioma (LGG), the indications of resection still remain a matter of debate, especially because of the frequent location of these tumors within eloquent brain areas - thus with a risk to induce a permanent postoperative deficit. Therefore, since the antagonist nature of this surgery is to perform the most extensive glioma removal possible, while preserving the function and the quality of life, new concepts were recently applied to LGG resection in order to optimize the benefit/risk ratio of the surgery.First, due to the development of functional mapping methods, namely perioperative neurofunctional imaging and intrasurgical direct electrical stimulation, the study of cortical functional organization is currently possible for each patient - in addition to an extensive neuropsychological assessment. Such knowledge is essential because of the inter-individual anatomo-functional variability, increased in tumors due to cerebral plasticity phenomena. Thus, brain mapping enables to envision and perform a resection according to individual functional boundaries.Second, since LGG invades not only cortical but also subcortical structures, and shows an infiltrative progression along the white matter tracts, new techniques of anatomical tracking and functional mapping of the subcortical white matter pathways were also used with the goal to study the individual effective connectivity - which needs imperatively to be preserved during the resection.Third, the better understanding of brain plasticity mechanisms, induced both by the slow-growing LGG and by the surgery itself, were equally studied in each patient and applied to the surgical strategy by incorporating individual dynamic potential of reorganization into the operative planning. The integration of these new concepts of individual functional mapping, connectivity and plastic potential to the surgery of LGG has allowed an extent of surgical indications, an optimization of the quality of resection (neuro-oncological benefit), and a minimization of the risk of sequelae (benefit on the quality of life). In addition, such a strategy has also fundamental applications, since it represents a new door to the connectionism and cerebral plasticity.

Bereitschaftspotentials recorded from the lateral part of the superior frontal gyrus in humans

To demonstrate the Bereitschaftspotentials (BPs) over the high lateral convexity in the superior frontal gyrus, movement-related cortical potentials with respect to the middle finger extension were recorded in seven patients with refractory epilepsy who underwent subdural implantation of platinum electrode grids and/or strips covering the high lateral frontal convexity. In two out of the seven patients, BPs were recorded from the electrodes placed on the superior frontal gyrus in the vicinity of the border between the medial and lateral frontal lobes, which were distinct from those recorded from the primary sensorimotor cortex. The results suggest the possible contribution of either the lateral dorsal non-primary motor area or the SMA to the generation of the BPs.

Evidence for a wide distribution of negative motor areas in the perirolandic cortex

OBJECTIVE

The perirolandic regions were studied by extensive electrical stimulation to clarify the topography and somatotopic distribution of negative motor areas (NMAs) and examine the clinical significance of these areas.

METHODS

We evaluated the cortical function elicited by electrical stimulation in 30 patients with tumors or intractable epilepsy. The somatotopic distribution of NMAs was examined by localizing these regions using Talairach's bicommissural reference system. NMAs within the lesions of two patients were removed under local anesthesia.

RESULTS

We obtained negative motor responses following the stimulation of 30 electrodes in 15 patients. On the lateral brain surface, the majority of NMAs for the upper extremities were distributed broadly throughout the premotor cortex, while NMAs for the tongue were only found in the inferior frontal gyrus of the dominant hemisphere. During removal of the NMAs within the lesions of two patients, we documented transient hand clumsiness in one patient.

CONCLUSIONS

NMAs were widely distributed throughout the perirolandic area, as well as the previously reported regions in the inferior frontal gyrus. These areas likely function in the control of skilled movements; dysfunction of such movements transiently follows resection of these regions, but is subsequently well compensated for after surgery.

SIGNIFICANCE

The localization and consequences of resection of NMAs suggests their clinical significance in motor control.

Negative myoclonus induced by cortical electrical stimulation in epileptic patients

Negative myoclonus (NM) is a motor disorder characterized by a sudden and abrupt interruption of muscular activity. The EMG correlate of NM is a brief (<500 ms) silent period (SP) not preceded by any enhancement of EMG activity (i.e. myoclonus). This study investigated the role of premotor cortex (PMC), primary motor cortex (MI), primary somatosensory area (SI) and supplementary motor area (SMA) in the pathophysiology of cortical NM by means of intracerebral low frequency (1 Hz) electrical stimulation. In three drug-resistant epileptic patients undergoing presurgical evaluation, we delivered single electric pulses (stimulus duration: 3 ms; stimulus intensity ranging from 0.4 to 3 mA) to PMC (2 patients), MI (1 patient), SI and SMA through stereo-EEG electrodes; surface EMG was collected from both deltoids. The results showed that (i) the stimulation of PMC or MI could evoke a motor evoked potential (MEP) either at rest or during contraction, in this latter case followed by an SP; however, in two patients, at the lowest stimulus intensities (0.4 mA), 50% of stimuli could induce a pure SP, i.e. not preceded by an MEP; raising the intensity of stimulation (0.6 mA), the SPs showed an antecedent MEP in >80% of stimuli; (ii) the stimulation of SI at low stimulus intensities (from 0.4 to 0.8 mA) induced in two patients only SPs, never associated with an antecedent MEP, whereas in the third subject the SPs could be inconstantly preceded by an MEP; by incrementing the stimulus intensity (up to 3 mA), in all three patients the SPs tended to be preceded, although not constantly, by an MEP; stimulus intensity affected SP duration (i.e. the higher the intensity, the longer the SP), without influencing the latency of onset of the SPs; (iii) the stimulation of SMA induced only pure SPs, at all stimulus intensities up to 3 mA; as for SI, increment of stimulus intensity was paralleled by an increase in SP duration, without influencing the onset latency of SPs. We conclude that single electric pulse stimulation of PMC, MI, SI and SMA through stereo-EEG electrodes can induce pure SPs, not preceded by an MEP, which clinically appear as NM, suggesting therefore that these cortical areas may be involved in the genesis of this motor phenomenon. However, it must be pointed out that SMA stimulation induced only pure SPs, regardless of the stimulus intensity, whereas occurrence of pure SPs following stimulation of PMC, MI, and SI depended mainly on the intensity of stimulation.

Arterial vascularization of primary motor cortex (precentral gyrus)

BACKGROUND

The precentral gyrus (PG) is the primary motor area and is one of the most eloquent brain regions of neurosurgical interest. Although the arterial supply to the PG is generally known, contributions from different arterial branches such as the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and middle cerebral artery (MCA) have not been comprehensively studied. The aim of the present study was to provide detailed information about the arteries of the PG.

METHODS

Twenty adult human brains (40 hemispheres) were obtained, and ACA, MCA, and PCA were separately cannulated and injected with latex. The PG was identified.

RESULTS

The ACA supplied the medial one third and the MCA supplied the lateral two thirds of the PG. The PCA did not reach the PG in any of the hemispheres. In 16 hemispheres (40%), the callosomarginal artery and, in 13 hemispheres (32.5%), the pericallosal artery were dominant for the medial one third of the PG. In 11 hemispheres (27.5%), equal dominance was observed. MCA branches at the lateral tip of the PG were classified into precentral, central, and postcentral groups. In 29 hemispheres (72.5%), the central group, and in 4 hemispheres (10%), the precentral group were dominant for the lateral two thirds of the PG. In 7 hemispheres (17.5%), the precentral and central groups were equally dominant. No dominance was identified for the postcentral group.

CONCLUSION

In each hemisphere, the PG was supplied by different vascularization patterns of ACA and MCA. The present study is the first to describe and discuss these details. Therefore, awareness of this pattern will provide a great contribution to surgical interventions.

Lateralized ictal immobility of the upper limb in patients with temporal lobe epilepsy

The primary aim of this study was to establish the incidence and the lateralizing value of 'lateralized ictal immobility of the upper limb' (LIL) in patients suffering from temporal lobe epilepsy (TLE), and to describe the connection between LIL and other clinical ictal signs. We retrospectively reviewed video records of 87 patients with TLE. We reviewed a total of 276 focal epileptic seizures with or without secondary generalization. We studied the incidence of LIL, its lateralizing value, and its relationship to other ictal clinical signs. Of the 87 patients, 49 had undergone a successful resective surgery at least 1 year prior to the study. LIL is a late sign in the course of partial seizure. It occurred in 25 of our 87 patients (28.7%), and in 47 of 276 seizures (17.1%). In all of the evaluated seizures, LIL occurred contralateral to the side of seizure onset (P < 0.001). LIL was always associated with ipsilateral upper limb automatisms, and in 63.1% of the occurrences, it was immediately followed by ictal dystonia. LIL is a more accurate term to describe what has previously been called 'ictal paresis' in the literature. Due to the inability to execute proper testing during a partial seizure, it is better to use the term LIL when making a visual analysis of a seizure. LIL is a more suitable term to describe the studied ictal sign. It is a relatively frequent sign in patients with TLE. LIL has an excellent lateralizing value for the contralateral hemisphere. It is a negative motor sign, and its genesis is probably associated with the epileptic involvement of the contralateral frontal lobe.

Lateralizing signs during seizures in focal epilepsy

This article reviews lateralizing semiological signs during epileptic seizures with respect to prediction of the side of the epileptogenic zone and, therefore, presurgical diagnostic value. The lateralizing significance of semiological signs and symptoms can frequently be concluded from knowledge of the cortical representation. Visual, auditory, painful, and autonomic auras, as well as ictal motor manifestations, e.g., version, clonic and tonic activity, unilateral epileptic spasms, dystonic posturing and unilateral automatisms, automatisms with preserved responsiveness, ictal spitting and vomiting, emotional facial asymmetry, unilateral eye blinking, ictal nystagmus, and akinesia, have been shown to have lateralizing value. Furthermore, ictal language manifestations and postictal features, such as Todd's palsy, postictal aphasia, postictal nosewiping, postictal memory dysfunction, as well as peri-ictal water drinking, peri-ictal headache, and ipsilateral tongue biting, are reviewed. Knowledge and recognition of semiological lateralizing signs during seizures is an important component of the presurgical evaluation of epilepsy surgery candidates and adds further information to video/EEG monitoring, neuroimaging, functional mapping, and neuropsychological evaluation.

Subdivisions of human parietal area 5 revealed by quantitative receptor autoradiography: a parietal region between motor, somatosensory, and cingulate cortical areas

Brodmann's area (BA) 5 of the human superior parietal cortex occupies a central anatomical position between the primary motor (BA 4), somatosensory (area 3b and BA 2), cingulate (area 23c), and superior parietal association cortex (BA 7). We studied the regional and laminar distributions of the binding sites of 12 different neurotransmitter receptors (glutamatergic: AMPA, kainate, NMDA; GABAergic: GABAA, GABAB; cholinergic: muscarinic M2, nicotinic; adrenergic: alpha1, alpha2; serotoninergic: 5-HT1A, 5-HT2; dopaminergic: D1) in human postmortem brains by means of quantitative receptor autoradiography, since the structural and functional aspects of human BA 5 are widely unknown, and previous observations have demonstrated characteristic differences in receptor distribution between motor and somatosensory areas. Binding site densities were measured in the cytoarchitectonically defined BA 5 and surrounding regions. Similarities and differences of receptor distribution between cortical areas were studied by cluster analysis of mean binding site densities averaged over all cortical layers, univariate and multivariate statistics, and by density profiles representing laminar receptor distribution patterns. Based on regional heterogeneities of binding site densities and of the cytoarchitecture within BA 5, we suggest a subdivision into three subareas: medial area 5M, lateral area 5L, and area 5Ci in the region around the cingulate sulcus. BA 5 is therefore a heterogeneous cortical region, comprising three subareas showing receptor expression patterns similar to the adjoining higher order somatosensory, multimodal parietal, or cingulate regions. These findings suggest that human BA 5 constitutes a higher order cortical area, clearly distinct from the primary somatosensory and motor cortex.

Transmitter receptors reveal segregation of cortical areas in the human superior parietal cortex: relations to visual and somatosensory regions

Regional distributions of ligand binding sites of 12 different neurotransmitter receptors (glutamatergic: AMPA, kainate, NMDA; GABAergic: GABA(A), GABA(B); cholinergic: muscarinic M2, nicotinic; adrenergic: alpha1, alpha2; serotonergic: 5-HT1A, 5-HT2; dopaminergic: D1) were studied in human postmortem brains by means of quantitative receptor autoradiography. Binding site densities were measured in the superior parietal lobule (SPL) (areas 5L, 5M, 5Ci, and different locations within Brodmann's area (BA) 7), somatosensory (BA 2), and visual cortical areas (BA 17, and different locations within BAs 18 and 19). Similarities of receptor distribution between cortical areas were analyzed by cluster analysis, uni- and multivariate statistics of mean receptor densities (averaged over all cortical layers), and profiles representing the laminar distribution patterns of receptors. A considerable heterogeneity of regional receptor densities and laminar patterns between the sites was found in the SPL and the visual cortex. The most prominent regional differences were found for M2 receptors. In the SPL, rostrocaudally oriented changes of receptor densities were more pronounced than those in mediolateral direction. The receptor distribution in the rostral SPL was more similar to that of the somatosensory cortex, whereas caudal SPL resembled the receptor patterns of the dorsolateral extrastriate visual areas. These results suggest a segregation of the different SPL areas based on receptor distribution features typical for somatosensory or visual areas, which fits to the dual functional role of this cortical region, i.e., the involvement of the human SPL in visuomotor and somatosensory motor transformations.

Somatosensory auras in focal epilepsy: A clinical, video EEG and MRI study

PURPOSE

To determine the clinical characteristics of somatosensory auras (SSA) and analyse features of seizure semiology predictive for localization in focal neocortical and limbic epilepsy.

METHODS

This study analyses the clinical, video-EEG and MRI imaging features of 75 consecutive patients with focal epilepsy who described somatosensory auras at seizure onset to determine the frequency and localising value of SSAs in different types of focal epilepsy. Sensory characteristics, somatotopic distribution, evolution of the auras and subsequent ictal features in relation to MRI and EEG findings were analysed.

RESULTS

The incidence of SSAs in 600 patients with focal epilepsy was 12%. Seventy-five patients were studied further: 77% reported tingling. Pain, thermal changes and a sense of movement or pulling were also reported. Distal unilateral auras in the hand and arm (46%) were most frequent and associated with a contralateral centroparietal focus. Contralateral auras were reported in 62% of lesional cases, focal cortical dysplasia was the commonest pathology in operated cases. Bilateral auras were associated with more diffuse pathologies or parasagittal foci. Evolution was centrifugal, somatotopic and usually unilaterally confined. Subsequent motor semiology was postural tonic, unilateral clonic, psychomotor or secondary generalized.

CONCLUSION

SSA are highly correlated with centroparietal epilepsy but may occur in temporal lobe, mesial frontal and multifocal epilepsy. A lesional etiology including discrete dysplasias, tumours, ischemic and postencephalitic gliosis is likely.

Propagation of tonic posturing in supplementary motor area (SMA) seizures

We analyzed ictal motor symptoms in 10 patients diagnosed to have supplementary motor area (SMA) seizures based on ictal encephalographic (EEG) findings and ictal clinical semiology. Inclusion criteria were (1) EEG seizure pattern in the vertex for the scalp recording or in the area over and/or adjacent to SMA for epicortical recording and (2) ictal motor semiology characterized, as previously reported, by sudden and a brief tonic posturing of extremities and trunk mainly occurring during sleep without loss of consciousness. In 50% (5/10) of the patients, tonic posturing began in one part of the body and moved to other part(s) in 5-10s. Unlike Jacksonian march seen in seizures involving the primary sensorimotor area (S1-M1), it spread in no accordance with the somatotopy in S1-M1. The sequential propagation of tonic posturing may represent the somatotopic organization within the SMA proper.

The motor cortex and facial expression: new insights from neuroscience

BACKGROUND

For more than a century, unusual and complex deficits in facial expression have been known to occur following localized brain damage. Some brain injuries leave the face with pronounced alterations in affect whereas others result in movement disorders such as blepharospasm and Meige syndrome. There is also a historic trail of clinical observations that document deficits in either voluntary or emotional control of the facial muscles following central nervous system damage.

REVIEW SUMMARY

Recent studies in the nonhuman primate cerebral cortex reveal the existence of multiple cortical facial representations in the frontal lobe and adjacent anterior cingulate cortex. These comprise the facial representation of the primary motor cortex (M1), ventral lateral premotor cortex (LPMCv), supplementary motor cortex (M2), rostral cingulate motor cortex (M3), and caudal cingulate motor cortex (M4). Homologous facial representations reside in the human brain based on observations following cortical stimulation, functional neuroimaging, and localized surgical resection. In the nonhuman primate, all these facial representations have been found to be directly interconnected through topographically organized corticocortical connections, and each facial area has also been found to send direct corticobulbar projections to the facial motor nucleus. The facial representations of M2 and M3 are both located on the medial wall of the hemisphere, in the vascular territory of the anterior cerebral artery. Both preferentially give rise to bilateral projections to parts of the facial nucleus that innervate the upper facial musculature as demonstrated in the monkey. The facial representation of M1, LPMCv, and M4 preferentially give rise to contralateral axonal projections ending in parts of the facial nucleus that innervate the lower facial musculature. The facial representation of M1 and LPMCv both reside in the vascular territory of the middle cerebral artery (MCA). The classic clinical presentation of paralysis in the contralateral lower facial musculature and intact bilateral upper facial musculature following typical MCA in infarction in the human parallels this mapping pattern of corticobulbar connections found in the nonhuman primate.

CONCLUSIONS

Facial movements are undoubtedly under the powerful influence of the cerebral cortex and are essential for the appropriate execution of many important functions such as mastication, swallowing, and social interaction, including speech and nonverbal communication. This information provides a theoretic template for interpreting the clinical effects of neuropathologic disease and localized cortical trauma on facial movements.

Physiological evidence for response inhibition in choice reaction time tasks

Inhibition is a widely used notion proposed to account for data obtained in choice reaction time (RT) tasks. However, this concept is weakly supported by empirical facts. In this paper, we review a series of experiments using Hoffman reflex, transcranial magnetic stimulation and electroencephalography to study inhibition in choice RT tasks. We provide empirical support for the idea that inhibition does occur during choice RT, and the implications of those findings for various classes of choice RT models are discussed.

Role of primary sensorimotor cortex and supplementary motor area in volitional swallowing: a movement-related cortical potential study

We investigated the role of the cerebral cortex, particularly the face/tongue area of the primary sensorimotor (SMI) cortex (face/tongue) and supplementary motor area (SMA), in volitional swallowing by recording movement-related cortical potentials (MRCPs). MRCPs with swallowing and tongue protrusion were recorded from scalp electrodes in eight normal right-handed subjects and from implanted subdural electrodes in six epilepsy patients. The experiment by scalp EEG in normal subjects revealed that premovement Bereitschaftspotentials (BP) activity for swallowing was largest at the vertex and lateralized to either hemisphere in the central area. The experiment by epicortical EEG in patients confirmed that face/tongue SMI and SMA were commonly involved in swallowing and tongue protrusion with overlapping distribution and interindividual variability. BP amplitude showed no difference between swallowing and tongue movements, either at face/tongue SMI or at SMA, whereas postmovement potential (PMP) was significantly larger in tongue protrusion than in swallowing only at face/tongue SMI. BP occurred earlier in swallowing than in tongue protrusion. Comparison between face/tongue SMI and SMA did not show any difference with regard to BP and PMP amplitude or BP onset time in either task. The preparatory role of the cerebral cortex in swallowing was similar to that in tongue movement, except for earlier activation in swallowing. Postmovement processing of swallowing was lesser than that of tongue movement in face/tongue SMI; probably suggesting that the cerebral cortex does not play a significant role in postmovement processing of swallowing. SMA plays a supplementary role to face/tongue SMI both in swallowing and tongue movements.

Preoperative mapping for patients with supplementary motor area epilepsy: multimodality brain mapping

Surgical management and strategies for the supplementary motor area (SMA) epilepsy are described. The following is our preoperative evaluations. The steps include functional magnetic resonance imaging (fMRI), interictal dipole tracing (DT), subdural electrodes mapping, measurements of movement-related cortical potential (MRCP), and the use of the intraoperative open MRI under conscious craniotomy. Six patients with SMA epilepsy underwent surgery after the mapping procedures and are now seizure-free. Combinations of preoperative (fMRI, subdural electrodes mapping) and intraoperative mapping allow exact localization and identification of the critical functional areas. Early postoperative deficits in motor and speech function were profound but patients recovered rapidly. It is concluded that the step of mapping procedures plays an important role in the management of SMA epilepsy surgery.

Sensing limb movements in the motor cortex: how humans sense limb movement

We can precisely control only what we can sense. Sensing limb position or limb movement is essential when we precisely control our limb movements. It has been generally believed that somatic perception takes place in the neuronal network of somatosensory areas. Recent neuroimaging techniques (PET, fMRI, transcranial magnetic stimulation) have revealed in human brains that motor areas participate in somatic perception of limb movements during kinesthetic illusion in the absence of actual limb movement. In particular, the primary motor cortex, which is an executive locus of voluntary limb movements, is primarily responsible for kinesthetic perception of limb movements. This probably forms the most efficient circuits for voluntary limb movements between the controlled muscles and the motor areas.