Role of the right dorsal premotor cortex in "physiological" mirror EMG activity

Voluntary suppression of associated activity decreases force steadiness in the active hand

Unilateral muscle contractions are often accompanied by the activation of the ipsilateral hemisphere, producing associated activity (AA) in the contralateral homologous muscles. However, the functional role of AA is not fully understood. We determined the effects of voluntary suppression of AA in the first dorsal interosseous (FDI), on force steadiness during a constant force isometric contraction of the contralateral FDI. Participants (n = 17, 25.5 years) performed two trials of isometric FDI contractions as steadily as possible. In Trial 1, they did not receive feedback or explicit instructions for suppressing the AA in the contralateral homologous FDI. In Trial 2, participants received feedback and were asked to voluntarily suppress the AA in the contralateral nontarget FDI. During both trials, corticospinal excitability and motor cortical inhibition were measured. The results show that participants effectively suppressed the AA in the nontarget contralateral FDI (-71%), which correlated with reductions in corticospinal excitability (-57%), and the suppression was also accompanied by increases in inhibition (27%) in the ipsilateral motor cortex. The suppression of AA impaired force steadiness, but the decrease in force steadiness did not correlate with the magnitude of suppression. The results show that voluntary suppression of AA decreases force steadiness in the active hand. However, due to the lack of association between suppression and decreased steadiness, we interpret these data to mean that specific elements of the ipsilateral brain activation producing AA in younger adults are neither contributing nor detrimental to unilateral motor control during a steady isometric contraction.

Brain-Machine Interface Induced Morpho-Functional Remodeling of the Neural Motor System in Severe Chronic Stroke

Brain-machine interfaces (BMI) permit bypass motor system disruption by coupling contingent neuroelectric signals related to motor activity with prosthetic devices that enhance afferent and proprioceptive feedback to the somatosensory cortex. In this study, we investigated neural plasticity in the motor network of severely impaired chronic stroke patients after an EEG-BMI-based treatment reinforcing sensorimotor contingency of ipsilesional motor commands. Our structural connectivity analysis revealed decreased fractional anisotropy in the splenium and body of the corpus callosum, and in the contralesional hemisphere in the posterior limb of the internal capsule, the posterior thalamic radiation, and the superior corona radiata. Functional connectivity analysis showed decreased negative interhemispheric coupling between contralesional and ipsilesional sensorimotor regions, and decreased positive intrahemispheric coupling among contralesional sensorimotor regions. These findings indicate that BMI reinforcing ipsilesional brain activity and enhancing proprioceptive function of the affected hand elicits reorganization of contralesional and ipsilesional somatosensory and motor-assemblies as well as afferent and efferent connection-related motor circuits that support the partial re-establishment of the original neurophysiology of the motor system even in severe chronic stroke.

Altered Granger causality connectivity within motor-related regions of patients with Parkinson's disease: a resting-state fMRI study

PURPOSE

Although numerous clinical neuroimaging studies have demonstrated that there are functional abnormalities of motor-related regions in patients with Parkinson's disease (PD) by resting-state functional magnetic resonance imaging (fMRI), little studies have explored the causal interactions within these motor-related regions. The present study aimed to examine Granger causality connectivity patterns within motor-related regions in PD patients.

METHODS

Resting-state fMRI was conducted to investigate the causal connectivity differences within motor-related regions between 17 PD patients and 17 matched healthy controls. Subsequently, the relationship between the Unified Parkinson's Disease Rating Scale scores and causal connectivity values within motor-related regions was examined in PD patients.

RESULTS

An increased causal connectivity from the left premotor cortex (PMC) to right primary motor cortex (M1) was found in PD patients compared with that of healthy controls. Also, increased causal flow from the PMC to M1 was negatively correlated with motor scores.

CONCLUSION

PD patients have abnormal causal connectivity in specific motor-related regions, which may reflect a compensatory role of motor deficits in PD patients.

Structural Neural Correlates of Physiological Mirror Activity During Isometric Contractions of Non-Dominant Hand Muscles

Mirror Activity (MA) describes involuntarily occurring muscular activity in contralateral homologous limbs during unilateral movements. This phenomenon has not only been reported in patients with neurological disorders (i.e. Mirror Movements) but has also been observed in healthy adults referred to as physiological Mirror Activity (pMA). However, despite recent hypotheses, the underlying neural mechanisms and structural correlates of pMA still remain insufficiently described. We investigated the structural correlates of pMA during isometric contractions of hand muscles with increasing force demands on a whole-brain level by means of voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS). We found significant negative correlations between individual tendencies to display pMA and grey matter volume (GMV) in the right anterior cingulate cortex (ACC) as well as fractional anisotropy (FA) of white matter (WM) tracts of left precuneus (PrC) during left (non-dominant) hand contractions. No significant structural associations for contractions of the right hand were found. Here we extend previously reported functional associations between ACC/PrC and the inhibtion of intrinsically favoured mirror-symmetrical movement tendencies to an underlying structural level. We provide novel evidence that the individual structural state of higher order motor/executive areas upstream of primary/secondary motor areas might contribute to the phenomen of pMA.

Functional connectivity alteration after real-time fMRI motor imagery training through self-regulation of activities of the right premotor cortex

Background

Real-time functional magnetic resonance imaging technology (real-time fMRI) is a novel method that can be used to investigate motor imagery training, it has attracted increasing attention in recent years, due to its ability to facilitate subjects in regulating the activities of specific brain regions to influence their behaviors. Lots of researchers have demonstrated that the right premotor area play critical roles during real-time fMRI motor imagery training. Thus, it has been hypothesized that modulating the activity of right premotor area may result in an alteration of the functional connectivity between the premotor area and other motor-related regions.

Results

The results indicated that the functional connectivity between the bilateral premotor area and right posterior parietal lobe significantly decreased during the imagination task.

Conclusions

This finding is new evidence that real-time fMRI is effective and can provide a theoretical guidance for the alteration of the motor function of brain regions associated with motor imagery training.

Electronic supplementary material

The online version of this article (doi:10.1186/s12868-015-0167-1) contains supplementary material, which is available to authorized users.

Lateralization of brain activity pattern during unilateral movement in Parkinson's disease

We investigated the lateralization of brain activity pattern during performance of unilateral movement in drug-naïve Parkinson's disease (PD) patients with only right hemiparkinsonian symptoms. Functional MRI was obtained when the subjects performed strictly unilateral right hand movement. A laterality index was calculated to examine the lateralization. Patients had decreased activity in the left putamen and left supplementary motor area, but had increased activity in the right primary motor cortex, right premotor cortex, left postcentral gyrus, and bilateral cerebellum. The laterality index was significantly decreased in PD patients compared with controls (0.41 ± 0.14 vs. 0.84 ± 0.09). The connectivity from the left putamen to cortical motor regions and cerebellum was decreased, while the interactions between the cortical motor regions, cerebellum, and right putamen were increased. Our study demonstrates that in early PD, the lateralization of brain activity during unilateral movement is significantly reduced. The dysfunction of the striatum-cortical circuit, decreased transcallosal inhibition, and compensatory efforts from cortical motor regions, cerebellum, and the less affected striatum are likely reasons contributing to the reduced motor lateralization. The disruption of the lateralized brain activity pattern might be a reason underlying some motor deficits in PD, like mirror movements or impaired bilateral motor coordination.

Role of the mirror-neuron system in cross-education

The present review proposes the untested hypothesis that cross-education performed with a mirror increases the transfer of motor function to the resting limb compared with standard cross-education interventions without a mirror. The hypothesis is based on neuroanatomical evidence suggesting an overlap in activated brain areas when a unilateral motor task is performed with and without a mirror in the context of cross-education of the upper extremities. The review shows that the mirror-neuron system (MNS), connecting sensory neurons responding to visual properties of an observed action and motor neurons that discharge action potentials during the execution of a similar action, has the potential to enhance cross-education.

Does abnormal interhemispheric inhibition play a role in mirror dystonia?

The presence of mirror dystonia (dystonic movement induced by a specific task performed by the unaffected hand) in the dominant hand of writer's cramp patients when the nondominant hand is moved suggests an abnormal interaction between the 2 hemispheres. In this study we compare the level of interhemispheric inhibition (IHI) in 2 groups of patients with writer's cramp, one with the presence of a mirror dystonia and the other without as well as a control group. The level of bidirectional IHI was measured in wrist muscles with dual-site transcranial magnetic stimulation with a 10-millisecond (short IHI) and a 40-millisecond (long IHI) interstimulus interval during rest and while holding a pen in 9 patients with mirror dystonia 7 without mirror dystonia, and 13 controls. The group of patients without mirror dystonia did not differ from the controls in their IHI level. In contrast, IHI was significantly decreased in the group of patients with mirror dystonia in comparison with the group without mirror dystonia and the controls in both wrist muscles of both the dystonic and unaffected hand whatever the resting or active condition (P = 0.001). The decrease of IHI level in the group of patients with mirror dystonia was negatively correlated with the severity and the duration of the disease: the weaker the level of IHI, the more severe was the disease and the longer its duration. Interhemispheric inhibition disturbances are most likely involved in the occurrence of mirror dystonia. This bilateral deficient inhibition further suggests the involvement of the unaffected hemisphere in the pathophysiology of unilateral dystonia.

A functional magnetic resonance imaging study of pathophysiological changes responsible for mirror movements in Parkinson's disease

Mirror movements correspond to involuntary movements observed in the limb contralateral to the one performing voluntary movement. They can be observed in Parkinson's disease (PD) but their pathophysiology remains unclear. The present study aims at identifying their neural correlates in PD using functional magnetic resonance imaging. Ten control subjects and 14-off drug patients with asymmetrical right-sided PD were included (8 with left-sided mirror movements during right-hand movements, and 6 without mirror movements). Between-group comparisons of BOLD signal were performed during right-hand movements and at rest (p<0.005 uncorrected). The comparison between PD patients with and without mirror movements showed that mirror movements were associated with an overactivation of the insula, precuneus/posterior cingulate cortex bilaterally and of the left inferior frontal cortex and with a deactivation of the right dorsolateral prefrontal cortex, medial prefrontal cortex, and pre-supplementary motor area and occipital cortex. These data suggest that mirror movements in Parkinson's disease are promoted by: 1- a deactivation of the non-mirroring inhibitory network (dorsolateral prefrontal cortex, pre-supplementary motor area); 2- an overactivation of prokinetic areas (notably the insula). The concomitant overactivation of a proactive inhibitory network (including the posterior cingulate cortex and precuneus) could reflect a compensatory inhibition of mirror movements.

Role of the dorsal premotor cortex in rhythmic auditory-motor entrainment: a perturbational approach by rTMS

Synchronization of body movements to an external beat is a universal human ability, which has also been recently documented in nonhuman species. The neural substrates of this rhythmic motor entrainment are still under investigation. Correlational neuroimaging data suggest an involvement of the dorsal premotor cortex (dPMC) and the supplementary motor area (SMA). In 14 healthy volunteers, we more specifically investigated the neural network underlying this phenomenon using a causal approach by an established 1-Hz repetitive transcranial magnetic stimulation (rTMS) protocol, which produces a focal suppression of cortical excitability outlasting the stimulation period. Synchronization accuracy between rhythmic cues and right index finger tapping, as measured by the mean time lag (asynchrony) between motor and auditory events, was significantly affected when the right dPMC function was transiently perturbed by "off-line" focal rTMS, whereas the reproduction of the rhythmic sequence per se (inter-tap-interval) was spared. This approach affected metrical rhythms of different complexity, but not non-metrical or isochronous sequences. Conversely, no change in auditory-motor synchronization was observed with rTMS of the SMA, of the left dPMC or over a control site (midline occipital area). Our data strongly support the view that the right dPMC is crucial for rhythmic auditory-motor synchronization in humans.

Interhemispheric control of unilateral movement

To perform strictly unilateral movements, the brain relies on a large cortical and subcortical network. This network enables healthy adults to perform complex unimanual motor tasks without the activation of contralateral muscles. However, mirror movements (involuntary movements in ipsilateral muscles that can accompany intended movement) can be seen in healthy individuals if a task is complex or fatiguing, in childhood, and with increasing age. Lateralization of movement depends on complex interhemispheric communication between cortical (i.e., dorsal premotor cortex, supplementary motor area) and subcortical (i.e., basal ganglia) areas, probably coursing through the corpus callosum (CC). Here, we will focus on transcallosal interhemispheric inhibition (IHI), which facilitates complex unilateral movements and appears to play an important role in handedness, pathological conditions such as Parkinson's disease, and stroke recovery.

Excessive contralateral motor overflow in schizophrenia measured by fMRI

Schizophrenia is characterized by significant problems in control of behavior; however, the disturbances in neural systems that control movement remain poorly characterized. We used functional magnetic resonance imaging (fMRI) to evaluate the origin of motor overflow in schizophrenia. Twenty-seven clinically stable medicated outpatients with Diagnostic and Statistical Manual, 4th edition, text revision (DSM-IV-TR)-defined schizophrenia (SZ), and 18 healthy control (HC) subjects, all right-handed, performed a dominant-handed, single-choice visual sensorimotor reaction time paradigm during fMRI. Voxel-wise analyses were conducted within sensorimotor cortical and striatal regions on general linear model (GLM)-derived measures of blood oxygen level-dependent (BOLD) signal change. The SZ group was not different from the HC group in reaction time, activation in somatosensory or motor cortices ipsilateral to the active (intended) descending corticospinal tract, nor visual cortex. However, in the right hemisphere (contralateral to the active M1), the SZ group showed significantly higher activation in primary motor cortex and adjacent premotor and somatosensory cortices (right Brodmann areas (BA) 1 through 4, and 6), and significantly lower activation in bilateral basal ganglia. Right BA 4 activation was strongly related to disorganization and poverty symptoms (and unrelated to medications) in the patient group. This study provides evidence in SZ of excessive neural activity in motor cortex contralateral to the intended primary motor cortex, which may form the basis for altered motor laterality and motor overflow previously observed, and disorganized behavior. This pathological motor overflow may be partly due to altered modulation of intended movement within the basal ganglia and premotor cortex.

Mirror movements in movement disorders: a review

BACKGROUND

Mirror movements (MM) are involuntary movements of homologous muscles during voluntary movements of contralateral body regions. While subtle mirroring can be present in otherwise healthy adults, overt MM may be common in many movement disorders. Examining these collective findings may further our understanding of MM and help define their usefulness as a clinical sign.

METHODS

We sought to review English language research articles examining the presence, clinical significance, and/or pathophysiology of MM in Parkinson's disease (PD), corticobasal syndrome (CBS), essential tremor (ET), focal hand dystonia, Creutzfeldt-Jakob's disease (CJD), and Huntington's disease. When available, MM in these disorders were compared with those of healthy age-matched controls and congenital disorders such as Klippel-Feil syndrome and X-linked Kallman's syndrome.

RESULTS

Clinical presentation of MM is common in asymmetric parkinsonian disorders (early PD, CBS) and manifests differently depending on the side affected (less affected hand in PD, more affected hand in CBS, either hand in ET, and both hands in healthy adults and congenital disorders), stage of disease (early, asymmetric PD and CJD), and presence of concomitant mirror-like overflow phenomena (focal dystonia and CBS-associated alien hand). In general, uncrossed descending corticospinal projections (congenital MM) and/or abnormal activation of the motor cortex ipsilateral to the voluntary task (most acquired MM), i.e., activation of the normal crossed corticospinal pathway, are required for the generation of MM.

DISCUSSION

MM are common motor phenomena and present differently in several acquired (mostly neurodegenerative) and congenital movement disorders. Future studies on MM will enhance the clinical diagnosis of selected movement disorders and contribute to our understanding of the normal physiology of bimanual coordination.

Tuning of the excitability of transcortical cutaneous reflex pathways during mirror-like activity

Voluntary contraction of a muscle generates electromyographic (EMG) activity in the homologous muscle on the opposite side (mirror-like activity), not only in pathological states and in infants but also in healthy adults. Few studies have examined whether the cutaneous reflexes during the preparatory period of a reaction time task are affected by mirror-like activity. In the present study, we investigated the modulation of the cutaneous reflexes in the left first interosseous (FDI) muscle in 9 healthy subjects while they performed a quick abduction of the right index finger during a reaction time task. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the left index finger. We found that mirror-like activity occurred in the left FDI at approximately the onset of EMG activity in the right FDI. The excitatory E2 component was selectively increased at ~75 ms after the "Go" signal, which corresponded to the onset of mirror-like activity. The inhibitory I2 (~90 ms) component was tuned consistently into excitation after the "Go" signal. These findings suggest that long latency reflexes, possibly transcortical cutaneous reflexes, are finely tuned in relation to mirror-like activity.

Transcallosal sensorimotor fiber tract structure-function relationships

Recent studies have demonstrated neuroanatomically selective relationships among white matter tract microstructure, physiological function, and task performance. Such findings suggest that the microstructure of transcallosal motor fibers may reflect the capacity for interhemispheric inhibition between the primary motor cortices, although full characterization of the transcallosal inhibitory sensorimotor network is lacking. Thus, the goal of this study was to provide a comprehensive description of transcallosal fibers connecting homologous sensorimotor cortical regions and to identify the relationship(s) between fiber tract microstructure and interhemispheric inhibition during voluntary cortical activity. To this end, we assessed microstructure of fiber tracts connecting homologous sensorimotor regions of the cortex with diffusion tensor imaging. We also assessed interhemispheric inhibition by eliciting the ipsilateral silent period (iSP) within the same participants. We mapped mutually exclusive transcallosal connections between homologous sensorimotor regions and computed quantitative metrics of each fiber tract. Paralleling work in non-human primates, we found the densest interhemispheric sensorimotor connections to be between the medial motor areas. Additionally, we provide a midsagittal callosal atlas in normalized Montreal Neurological Institute (MNI) space for future studies to use when investigating callosal fiber tracts connecting primary and secondary sensorimotor cortices. Finally, we report a strong, positive relationship (r = 0.76) between strength of interhemispheric inhibition (iSP) and microstructure of interhemispheric fibers that is specific to tracts connecting the primary motor cortices. Thus, increased fiber microstructure in young adults predicts interhemispheric inhibitory capacity.

Task-dependent effects of interhemispheric inhibition on motor control

Interhemispheric communication consists of a complex balance of facilitation and inhibition that is modulated in a task-dependent manner. However, it remains unclear how individual differences in interhemispheric interactions relate to motor performance. To assess interhemispheric inhibition, we utilized the ipsilateral silent period technique (iSP; evoked by suprathreshold transcranial magnetic stimulation), which elicits inhibition of volitional motor activity. Participants performed three force production tasks: (1) unimanual (right hand) constant force, (2) bimanual constant force, (bimanual simultaneous) and (3) bimanual with right hand constant force and left hand sine wave tracking (bimanual independent). We found that individuals with greater IHI capacity demonstrated reduced mirror EMG activity in the left hand during unimanual right hand contraction. However, these same individuals demonstrated the poorest performance during the bimanual independent force production task. We suggest that a high capacity for IHI from one motor cortex to another can effectively prevent "motor overflow" during unimanual tasks, but it can also limit interhemispheric cooperation during independently controlled bimanual tasks.

Relative or absolute? Implications and consequences of the measures adopted to investigate motor overflow

Motor overflow is involuntary overt movement or covert muscle activity that cooccurs with voluntary movement. Overflow is present in several pathological conditions, as well as in neurologically healthy children and older adults, and can be induced in healthy young adults under effortful conditions. This motor phenomenon may provide insight into the underlying mechanisms and kinetic characteristics of voluntary and involuntary motor control in various populations. Although often measured behaviorally using force transduction techniques, different methods of calculating and presenting such overflow data have resulted in seemingly contradictory findings, with limited discussion of the advantages and limitations of different approaches. In this article, the authors examined the relevant literature to highlight significant methodological considerations for authors and readers conducting or appraising this type of research. Issues regarding the interpretation and reporting of findings are also discussed. Researchers are encouraged to continue using behavioral measures to create well-defined variables that enable the study of the kinematic characteristics of overflow, as these may offer promising new ways forward in better characterizing and understanding this intriguing movement phenomenon.

Age differences in interhemispheric interactions: callosal structure, physiological function, and behavior

There is a fundamental gap in understanding how brain structural and functional network connectivity are interrelated, how they change with age, and how such changes contribute to older adults’ sensorimotor deficits. Recent neuroimaging approaches including resting state functional connectivity MRI (fcMRI) and diffusion tensor imaging (DTI) have been used to assess brain functional (fcMRI) and structural (DTI) network connectivity, allowing for more integrative assessments of distributed neural systems than in the past. Declines in corpus callosum size and microstructure with advancing age have been well documented, but their contributions to age deficits in unimanual and bimanual function are not well defined. Our recent work implicates age-related declines in callosal size and integrity as a key contributor to unimanual and bimanual control deficits. Moreover, our data provide evidence for a fundamental shift in the balance of excitatory and inhibitory interhemispheric processes that occurs with age, resulting in age differences in the relationship between functional and structural network connectivity. Training studies suggest that the balance of interhemispheric interactions can be shifted with experience, making this a viable target for future interventions.

What have We Learned from "Perturbing" the Human Cortical Motor System with Transcranial Magnetic Stimulation?

The purpose of this paper is twofold. First, we will review different approaches that one can use with transcranial magnetic stimulation (TMS) to study both its effects on motor behavior and on neural connections in the human brain. Second, we will present evidence obtained in TMS-based studies showing that the dorsal premotor area (PMd), the ventral premotor area (PMv), the supplementary motor area (SMA), and the pre-supplementary motor area (pre-SMA) each have different roles to play in motor behavior. We highlight the importance of the PMd in response selection based on arbitrary cues and in the control of arm movements, the PMv in grasping and in the discrimination of bodily actions, the SMA in movement sequencing and in bimanual coordination, and the pre-SMA in cognitive control. We will also discuss ways in which TMS can be used to chart “true” cerebral reorganization in clinical populations and how TMS might be used as a therapeutic tool to facilitate motor recovery after stroke. We will end our review by discussing some of the methodological challenges and future directions for using this tool in basic and clinical neuroscience.

Functional neuroanatomy of mirroring during a unimanual force generation task

Performance of a unimanual motor task often induces involuntary mirror electromyographic (EMG) activity in the opposite, resting hand. In spite of the ubiquitous presence of mirroring, little is known regarding the underlying cortical contributions. Here, we used functional magnetic resonance imaging (fMRI) to study brain regions activated in association with parametric increases in right isometric wrist flexion force (10%, 20%, 30%, and 70%) in 12 healthy volunteers. During scanning, EMG activity was recorded bilaterally from flexor carpi radialis (FCR), extensor carpi radialis (ECR), biceps brachii (BB), and triceps brachii (TB). Mirror EMG was observed in left FCR during 20%, 30%, and 70% of force. Left ECR, BB, and TB showed mirror EMG only at 70% of force. Increasing force was associated with a linear increase of blood-oxygen-level-dependent (BOLD) signal in bilateral primary motor cortex (M1), supplementary motor area (SMA), caudal cingulate, and cerebellum. Mirroring in the left FCR correlated with activity in bilateral M1, SMA, and the cerebellum. Overall, our results suggest that activity in these regions might reflect sensorimotor processes operating in association with mirroring and suggest caution when interpreting fMRI activity in studies that involve unilateral force generation tasks in the absence of simultaneous bilateral EMG/kinematics measurements.

Hemispheric asymmetries of the premotor cortex are task specific as revealed by disruptive TMS during bimanual versus unimanual movements

The premotor cortex (PMC) is functionally lateralized, such that the left PMC is activated for unimanual movements of either hand, whereas the right PMC is particularly active during complex bimanual movements. Here we ask the question whether the high activation of right PMC in the bimanual context reflects either hemispheric specialization or handedness. Left- and right-handed subjects performed a bimanual antiphase tapping task at different frequencies while transcranial magnetic stimulation (TMS) was used to temporarily disrupt left versus right PMC during complex bimanual movements. For both handedness groups, more disruptions were induced when TMS was applied over the motor nondominant PMC than over the motor dominant PMC or when sham-TMS was used. In a second experiment, right-handers performed complex unimanual tapping with either hand, while TMS was applied to the PMC in both hemispheres. The novel result was that the high susceptibility of the motor nondominant PMC was specific to the bimanual context, indicating that hemispheric asymmetries of the PMC depend on the bimanual versus unimanual nature of the motor task. We hypothesize that asymmetries of PMC involvement in bimanual control reflect interhemispheric interactions, whereby the motor nondominant PMC appears to prevent motor cross talk arising from the dominant hemisphere.

Modulation of interhemispheric inhibition by volitional motor activity: an ipsilateral silent period study

Brief interruption of voluntary EMG in a hand muscle by focal transcranial magnetic stimulation (TMS) of the ipsilateral primary motor cortex (M1), the so-called ipsilateral silent period (ISP), is a measure of interhemispheric motor inhibition. However, little is known about how volitional motor activity would modulate the ISP. Here we tested in 30 healthy adults to what extent and under what conditions voluntary activation of the stimulated right M1 by moving the left hand strengthens interhemispheric inhibition as indexed by an enhancement of the ISP area in the maximally contracting right first dorsal interosseous (FDI). Left index finger abduction, already at low levels of contraction, significantly enhanced the ISP compared to left hand at rest. Even imagination of left index finger movement enhanced the ISP compared to rest or mental calculation. This enhancement occurred in the absence of motor-evoked potential amplitude modulation in the left FDI, thus excluding a non-specific contribution from an increase in right M1 corticospinal excitability. Contraction of the left extensor indicis, but not contraction of more proximal left upper limb or left or right lower limb muscles also enhanced the ISP. A reaction time experiment showed that the ISP enhancement developed at a late stage of movement preparation just before or at movement onset. Interhemispheric inhibition of the motor-evoked potential as tested by a bifocal paired-pulse TMS protocol and thought to be mediated via a neuronal circuit different to the ISP was not enhanced when tested under identical motor task conditions. Finally, ISP enhancement by contraction of the left FDI correlated inversely with EMG mirror activity in the right FDI during phasic abductions of the left index finger. Our findings strongly suggest that voluntary M1 activation by real or imagined movement of the contralateral hand increases interhemispheric motor inhibition of the opposite M1. This phenomenon shows substantial topographical, temporal and neuronal circuit specificity, and has functional significance as it probably plays a pivotal role in suppressing mirror activity.

Motor overflow and mirror dystonia

Motor overflow is an unintentional muscle contraction which accompanies, but is anatomically distinct from the primary dystonic movement. This phenomenological nosology has not been systematically studied in focal hand dystonia (FHD). We conducted a prospective, case-control study to characterize motor overflow and mirror dystonia in patients with FHD. We compared the performance of 30 patients with FHD and 40 healthy controls on a variety of motor tasks, such as writing, drawing a spiral, straight line and a sine wave, repetitive wrist flexion-extension, finger tapping, hand grasping, hand pronation-supination, and a finger-to-nose task with each hand. The assessments were videotaped, the edited video segments were randomized, and an independent investigator who was "blind" to the subject's diagnosis rated the ipsilateral and contralateral overflow and mirror dystonia twice, 6 months apart. Using the mean of the two ratings, ipsilateral overflow was identified in 8.5 +/- 2.1 (28%) patients and in 1.5 +/- 0.7 (4%) controls (p < 0.001), contralateral overflow in 2.5 +/- 0.7 (8%) patients and in 1.5 +/- 0.7 (4%) of controls (p = 0.138), and mirror movement in 20.0 +/- 0.0 (67%) of patients and in 15.5 +/- 4.9 (39%) of controls (p = 0.001). There was a statistically significant correlation of dystonia and overflow score (Pearson's r 0.713, p < 0.001). The relatively high frequency of ipsilateral overflow and mirror dystonia in patients with FHD has both pathophysiological and therapeutic implications. In this study, the severity of dystonia was significantly correlated with motor overflow in multiple tasks.