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Bellacicca A, Rossi M, Viganò L, Simone L, Howells H, Gambaretti M, Gallotti A, Leonetti A, Puglisi G, Talami F, Bello L, Gabriella C, Fornia L. Peaglet: A user-friendly probabilistic Kernel density estimation of intracranial cortical and subcortical stimulation sites. J Neurosci Methods 2024; 408:110177. [PMID: 38795978 DOI: 10.1016/j.jneumeth.2024.110177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/18/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Data on human brain function obtained with direct electrical stimulation (DES) in neurosurgical patients have been recently integrated and combined with modern neuroimaging techniques, allowing a connectome-based approach fed by intraoperative DES data. Within this framework is crucial to develop reliable methods for spatial localization of DES-derived information to be integrated within the neuroimaging workflow. NEW METHOD To this aim, we applied the Kernel Density Estimation for modelling the distribution of DES sites from different patients into the MNI space. The algorithm has been embedded in a MATLAB-based User Interface, Peaglet. It allows an accurate probabilistic weighted and unweighted estimation of DES sites location both at cortical level, by using shortest path calculation along the brain 3D geometric topology, and subcortical level, by using a volume-based approach. RESULTS We applied Peaglet to investigate spatial estimation of cortical and subcortical stimulation sites provided by recent brain tumour studies. The resulting NIfTI maps have been anatomically investigated with neuroimaging open-source tools. COMPARISON WITH EXISTING METHODS Peaglet processes differently cortical and subcortical data following their distinguishing geometrical features, increasing anatomical specificity of DES-related results and their reliability within neuroimaging environments. CONCLUSIONS Peaglet provides a robust probabilistic estimation of the cortical and subcortical distribution of DES sites going beyond a region of interest approach, respecting cortical and subcortical intrinsic geometrical features. Results can be easily integrated within the neuroimaging workflow to drive connectomic analysis.
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Affiliation(s)
- Andrea Bellacicca
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano 20122, Italy
| | - Marco Rossi
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano 20122, Italy
| | - Luca Viganò
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano 20122, Italy
| | - Luciano Simone
- Department of Medicine and Surgery, Università Degli Studi di Parma, Parma 43125, Italy
| | - Henrietta Howells
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano 20122, Italy
| | - Matteo Gambaretti
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano 20122, Italy
| | - Alberto Gallotti
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano 20122, Italy
| | - Antonella Leonetti
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano 20122, Italy
| | - Guglielmo Puglisi
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano 20122, Italy
| | - Francesca Talami
- Consiglio Nazionale Delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano 20122, Italy
| | - Cerri Gabriella
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano 20122, Italy
| | - Luca Fornia
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano 20122, Italy.
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Franco-Rosado P, Callejón MA, Reina-Tosina J, Roa LM, Martin-Rodriguez JF, Mir P. Addressing the sources of inter-subject variability in E-field parameters in anodal tDCS stimulation over motor cortical network. Phys Med Biol 2024; 69:145013. [PMID: 38917834 DOI: 10.1088/1361-6560/ad5bb9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/25/2024] [Indexed: 06/27/2024]
Abstract
Objetive: .Although transcranial direct current stimulation constitutes a non-invasive neuromodulation technique with promising results in a great variety of applications, its clinical implementation is compromised by the high inter-subject variability reported. This study aims to analyze the inter-subject variability in electric fields (E-fields) over regions of the cortical motor network under two electrode montages: the classical C3Fp2 and an alternative P3F3, which confines more the E-field over this region.Approach.Computational models of the head of 98 healthy subjects were developed to simulate the E-field under both montages. E-field parameters such as magnitude, focality and orientation were calculated over three regions of interest (ROI): M1S1, supplementary motor area (SMA) and preSMA. The role of anatomical characteristics as a source of inter-subject variability on E-field parameters and individualized stimulation intensity were addressed using linear mixed-effect models.Main results.P3F3 showed a more confined E-field distribution over M1S1 than C3Fp2; the latter elicited higher E-fields over supplementary motor areas. Both montages showed high inter-subject variability, especially for the normal component over C3Fp2. Skin, bone and CSF ROI volumes showed a negative association with E-field magnitude irrespective of montage. Grey matter volume and montage were the main sources of variability for focality. The curvature of gyri was found to be significantly associated with the variability of normal E-fields.Significance.Computational modeling proves useful in the assessment of E-field variability. Our simulations predict significant differences in E-field magnitude and focality for C3Fp2 and P3F3. However, anatomical characteristics were also found to be significant sources of E-field variability irrespective of electrode montage. The normal E-field component better captured the individual variability and low rate of responder subjects observed in experimental studies.
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Affiliation(s)
- Pablo Franco-Rosado
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
- Departamento de Psicología Experimental, Universidad de Sevilla, Sevilla, Spain
| | - M Amparo Callejón
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Javier Reina-Tosina
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
| | - Laura M Roa
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
| | - Juan F Martin-Rodriguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Psicología Experimental, Universidad de Sevilla, Sevilla, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
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Hamer RP, Praeger AJ. Facilitating complete resection of intrinsic motor cortex glioma with titration of high-frequency cortico-subcortical mapping train count informed by navigated transcranial magnetic stimulation: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24197. [PMID: 38976917 DOI: 10.3171/case24197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/18/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The dilemma of neuro-oncological surgery involving suspected eloquent cortex is to maximize the extent of resection while minimizing neurological morbidity, referred to as the "onco-functional balance." Diffuse lower-grade gliomas are capable of infiltrating or displacing neural function within cortical regions and subcortical white matter tracts, which can render classical anatomic associations of eloquent function misleading. OBSERVATIONS This study employed presurgical navigated transcranial magnetic stimulation (nTMS) to determine the motor eloquence of a diffuse lower-grade glioma at the superior frontal gyrus extending and intrinsic to the primary motor cortex in a 45-year-old female. Positive nTMS findings were confirmed intraoperatively with high-frequency direct cortico-subcortical stimulation (HF-DCS). Modification of the HF-DCS train count from train-of-five to train-of-two permitted resection beyond classic anatomical boundaries and conventional HF-DCS safe stopping criteria. LESSONS Anatomical correlates of function can inaccurately inform the surgical management of diffuse lower-grade glioma, which represents the utmost opportunity for progression-free survival. Integrating an individually tailored nTMS-DCS surgical strategy contributed to complete resection, negating the requirement for adjuvant therapy. Serial nTMS follow-up may assist with the characterization of tumor-induced functional reorganization. https://thejns.org/doi/10.3171/CASE24197.
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Affiliation(s)
- Ryan P Hamer
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian J Praeger
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia and
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Zhang JJ, Yang YL, Hu J, Zhao CF, He XH, Yang QY, Qi XS, Lu H, He C, Liu H. Development and validation of a novel model based on hand knob score and white matter injury on MRI to predict hand function in children with cerebral palsy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1102. [PMID: 36388818 PMCID: PMC9652546 DOI: 10.21037/atm-22-4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND Childhood hand function is considered to be one of the strongest predictors of the ability to participate in daily activities as children with cerebral palsy (CP) reach adulthood. The manual ability classification system (MACS) is currently the most widely used for grading hand function in children with CP. However, the MACS method is subjective and may be affected by the raters' experience. Hand knob is an important control center for hand movement. Therefor this study aimed to develop and validate an objective model for hand function estimation in children with CP and visualize it as a nomogram. METHODS A total of 70 Children (2-12 years old) with CP underwent magnetic resonance imaging (MRI) scanning, MACS assessment. According to MACS, children with CP were divided into mild impairment group (grade I-III) and severe impairment group (grade IV-V). Hand function prediction models based on (I) hand knob score, (II) clinical features, and (III) the combination of clinical features and hand knob score were developed and validated separately. The models were subjected to stepwise regression according to the maximum likelihood method, and the Akaike information criterion was used to select the best model. Model discrimination was assessed using receiver operating characteristic (ROC) and calibration curves. The nomogram was finally built according to the best model. RESULTS The area under the curve (AUC) of the hand knob score model in the training set was 0.752, the clinical features model was 0.819, and the hand knob score and clinical features combined model was 0.880. The AUC of the hand knob score model in the validation set was 0.765, the clinical features model was 0.782, and the combined model was 0.894. The best model was the hand knob score-clinical features combined model, and the nomogram finally incorporated two assessment items: the hand knob score and white matter injury. The estimated probability of hand function injury degree of the combined model displayed good agreement with the actual occurrence probability. CONCLUSIONS The hand knob score-clinical features combined model can be used to preliminarily assess the degree of hand impairment in children with CP, with good calibration.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Radiology, Mianyang Hospital of T.C.M, Mianyang, China
| | - Yan-Li Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Hu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chun-Feng Zhao
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xing-Hong He
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian-Yu Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Shan Qi
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Lu
- Department of Radiology, The Seventh People’s Hospital of Chongqing, The Central Hospital Affiliated to Chongqing University of Technology, Chongqing, China
| | - Cheng He
- Medical Imaging Department, Chongqing University Central Hospital, Chongqing, China
| | - Heng Liu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Bonzano L, Bortoletto M, Zazio A, Iester C, Stango A, Gasparotti R, Miniussi C, Bove M. The hand motor hotspot for seed-based functional connectivity of hand motor networks at rest. Front Neurosci 2022; 16:896746. [PMID: 36033609 PMCID: PMC9412736 DOI: 10.3389/fnins.2022.896746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/21/2022] [Indexed: 12/05/2022] Open
Abstract
In the seed-based method for studying functional connectivity (FC), seed selection is relevant. Here, we propose a new methodological approach for resting-state FC analysis of hand motor networks using the individual hand motor hotspot (hMHS) as seed. Nineteen right-handed healthy volunteers underwent a transcranial magnetic stimulation (TMS) session and resting-state fMRI. For each subject, the hMHS in both hemispheres was identified by TMS with the contralateral abductor pollicis brevis muscle as the target, the site eliciting the highest and most reliable motor-evoked potentials. Seed regions were built on coordinates on the cortex corresponding to the individual left and right hMHSs. For comparison, the left and right Brodmann’s area 4 (BA4) masks extracted from a standard atlas were used as seed. The left and right hMHSs showed FC patterns at rest mainly including sensorimotor regions, with a bilateral connectivity only for the left hMHS. The statistical contrast BA4 > hMHS for both hemispheres showed different extension and lateralization of the functionally connected cortical regions. On the contrary, no voxels survived the opposite contrast (hMHS > BA4). This suggests that detection of individual hand motor seeds by TMS allows to identify functionally connected motor networks that are more specific with respect to those obtained starting from the a priori atlas-based identification of the primary motor cortex.
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Affiliation(s)
- Laura Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bortoletto
- Neurophysiology Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agnese Zazio
- Neurophysiology Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Costanza Iester
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonietta Stango
- Neurophysiology Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberto Gasparotti
- Section of Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
- *Correspondence: Marco Bove,
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Tian D, Izumi SI. Transcranial Magnetic Stimulation and Neocortical Neurons: The Micro-Macro Connection. Front Neurosci 2022; 16:866245. [PMID: 35495053 PMCID: PMC9039343 DOI: 10.3389/fnins.2022.866245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022] Open
Abstract
Understanding the operation of cortical circuits is an important and necessary task in both neuroscience and neurorehabilitation. The functioning of the neocortex results from integrative neuronal activity, which can be probed non-invasively by transcranial magnetic stimulation (TMS). Despite a clear indication of the direct involvement of cortical neurons in TMS, no explicit connection model has been made between the microscopic neuronal landscape and the macroscopic TMS outcome. Here we have performed an integrative review of multidisciplinary evidence regarding motor cortex neurocytology and TMS-related neurophysiology with the aim of elucidating the micro–macro connections underlying TMS. Neurocytological evidence from animal and human studies has been reviewed to describe the landscape of the cortical neurons covering the taxonomy, morphology, circuit wiring, and excitatory–inhibitory balance. Evidence from TMS studies in healthy humans is discussed, with emphasis on the TMS pulse and paradigm selectivity that reflect the underlying neural circuitry constitution. As a result, we propose a preliminary neuronal model of the human motor cortex and then link the TMS mechanisms with the neuronal model by stimulus intensity, direction of induced current, and paired-pulse timing. As TMS bears great developmental potential for both a probe and modulator of neural network activity and neurotransmission, the connection model will act as a foundation for future combined studies of neurocytology and neurophysiology, as well as the technical advances and application of TMS.
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Affiliation(s)
- Dongting Tian
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine, Sendai, Japan
- *Correspondence: Dongting Tian,
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduates School of Medicine, Sendai, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Shin-Ichi Izumi,
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Wu F, Zhao H, Zhang Y, Wang M, Liu C, Wang X, Cheng Y, Jin C, Yang J, Li X. Morphologic Variants of the Hand Motor Cortex in Developing Brains from Neonates through Childhood Assessed by MR Imaging. AJNR Am J Neuroradiol 2022; 43:292-298. [PMID: 34992126 PMCID: PMC8985685 DOI: 10.3174/ajnr.a7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Knowledge of anatomic markers of the hand motor cortex is essential in the evaluation and treatment of motor neurologic diseases for both adults and developing populations. However, hand motor cortex variants in developing brains remain to be investigated. Our objective was to observe morphologic variants of the hand motor cortex in developing brains from neonates through childhood. MATERIALS AND METHODS In this study, 542 participants (0∼15 years of age) were retrospectively enrolled and divided into different age groups. The hand motor cortex morphology was evaluated on the basis of 3D T1WI. Variations in hand motor cortex variants were compared among different age groups. Inter-gender and interhemispheric differences of hand motor cortex variants were also evaluated. RESULTS Various hand motor cortex variants could be observed in developing brains, even in the neonatal period. One new morphologic shape, "immature Ω," was found in neonates and infants. The proportion of this new shape decreased dramatically during the first year after birth, then disappeared after 1 year of age. It persisted for a longer time in the right hemisphere and in males. However, sex or hemispheric effects on the distribution of the proportion of variants were not statistically significant. Furthermore, the proportion of concordance of the bilateral hand motor cortex showed an increasing trend with age (P = .006), higher in females than males. CONCLUSIONS Various hand motor cortex variants already existed at birth. The distribution of proportions of different variants developmentally varied during the first year after birth and became stable after 1 year of age. The concordance of the bilateral hand motor cortex could be influenced by age and sex.
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Affiliation(s)
- F. Wu
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Department of Radiology (F.W.), Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - H. Zhao
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Y. Zhang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - M. Wang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - C. Liu
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - X. Wang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Y. Cheng
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - C. Jin
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - J. Yang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - X. Li
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Fornia L, Rossi M, Rabuffetti M, Bellacicca A, Viganò L, Simone L, Howells H, Puglisi G, Leonetti A, Callipo V, Bello L, Cerri G. Motor impairment evoked by direct electrical stimulation of human parietal cortex during object manipulation. Neuroimage 2021; 248:118839. [PMID: 34963652 DOI: 10.1016/j.neuroimage.2021.118839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/03/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022] Open
Abstract
In primates, the parietal cortex plays a crucial role in hand-object manipulation. However, its involvement in object manipulation and related hand-muscle control has never been investigated in humans with a direct and focal electrophysiological approach. To this aim, during awake surgery for brain tumors, we studied the impact of direct electrical stimulation (DES) of parietal lobe on hand-muscles during a hand-manipulation task (HMt). Results showed that DES applied to fingers-representation of postcentral gyrus (PCG) and anterior intraparietal cortex (aIPC) impaired HMt execution. Different types of EMG-interference patterns were observed ranging from a partial (task-clumsy) or complete (task-arrest) impairment of muscles activity. Within PCG both patterns coexisted along a medio (arrest)-lateral (clumsy) distribution, while aIPC hosted preferentially the task-arrest. The interference patterns were mainly associated to muscles suppression, more pronounced in aIPC with respect to PCG. Moreover, within PCG were observed patterns with different level of muscle recruitment, not reported in the aIPC. Overall, EMG-interference patterns and their probabilistic distribution suggested the presence of different functional parietal sectors, possibly playing different roles in hand-muscle control during manipulation. We hypothesized that task-arrest, compared to clumsy patterns, might suggest the existence of parietal sectors more closely implicated in shaping the motor output.
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Affiliation(s)
- Luca Fornia
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Italy; IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Italy
| | | | - Andrea Bellacicca
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Italy
| | - Luca Viganò
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Italy
| | - Luciano Simone
- Cognition, Motion & Neuroscience, Center for Human Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Henrietta Howells
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Italy
| | - Guglielmo Puglisi
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Italy
| | - Antonella Leonetti
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Italy
| | - Vincenzo Callipo
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Humanitas Research Hospital IRCSS, Rozzano, Milano, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Italy
| | - Gabriella Cerri
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Humanitas Research Hospital IRCSS, Rozzano, Milano, Italy.
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Viganò L, Howells H, Rossi M, Rabuffetti M, Puglisi G, Leonetti A, Bellacicca A, Conti Nibali M, Gay L, Sciortino T, Cerri G, Bello L, Fornia L. Stimulation of frontal pathways disrupts hand muscle control during object manipulation. Brain 2021; 145:1535-1550. [PMID: 34623420 PMCID: PMC9128819 DOI: 10.1093/brain/awab379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
The activity of frontal motor areas during hand-object interaction is coordinated by dense communication along specific white matter pathways. This architecture allows the continuous shaping of voluntary motor output and, despite extensively investigated in non-human primate studies, remains poorly understood in humans. Disclosure of this system is crucial for predicting and treatment of motor deficits after brain lesions. For this purpose, we investigated the effect of direct electrical stimulation on white matter pathways within the frontal lobe on hand-object manipulation. This was tested in thirty-four patients (15 left hemisphere, mean age 42 years, 17 male, 15 with tractography) undergoing awake neurosurgery for frontal lobe tumour removal with the aid of the brain mapping technique. The stimulation outcome was quantified based on hand-muscle activity required by task execution. The white matter pathways responsive to stimulation with an interference on muscles were identified by means of probabilistic density estimation of stimulated sites, tract-based lesion-symptom (disconnectome) analysis and diffusion tractography on the single patient level. Finally, we assessed the effect of permanent tracts disconnection on motor outcome in the immediate postoperative period using a multivariate lesion-symptom mapping approach. The analysis showed that stimulation disrupted hand-muscle activity during task execution in 66 sites within the white matter below dorsal and ventral premotor regions. Two different EMG interference patterns associated with different structural architectures emerged: 1) an arrest pattern, characterised by complete impairment of muscle activity associated with an abrupt task interruption, occurred when stimulating a white matter area below the dorsal premotor region. Local mid-U-shaped fibres, superior fronto-striatal, corticospinal and dorsal fronto-parietal fibres intersected with this region. 2) a clumsy pattern, characterised by partial disruption of muscle activity associated with movement slowdown and/or uncoordinated finger movements, occurred when stimulating a white matter area below the ventral premotor region. Ventral fronto-parietal and inferior fronto-striatal tracts intersected with this region. Finally, only resections partially including the dorsal white matter region surrounding the supplementary motor area were associated with transient upper-limb deficit (p = 0.05; 5000 permutations). Overall, the results identify two distinct frontal white matter regions possibly mediating different aspects of hand-object interaction via distinct sets of structural connectivity. We suggest the dorsal region, associated with arrest pattern and post-operative immediate motor deficits, to be functionally proximal to motor output implementation, while the ventral region may be involved in sensorimotor integration required for task execution.
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Affiliation(s)
- Luca Viganò
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Henrietta Howells
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Marco Rabuffetti
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milano, Italy
| | - Guglielmo Puglisi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano.,MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Antonella Leonetti
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Andrea Bellacicca
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Marco Conti Nibali
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Lorenzo Gay
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Tommaso Sciortino
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Gabriella Cerri
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Luca Fornia
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
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Targeting Primary Motor Cortex (M1) Functional Components in M1 Gliomas Enhances Safe Resection and Reveals M1 Plasticity Potentials. Cancers (Basel) 2021; 13:cancers13153808. [PMID: 34359709 PMCID: PMC8345096 DOI: 10.3390/cancers13153808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Primary-Motor-Cortex (M1) hosts two functional components, at its posterior and anterior borders, the first being faster and more excitable than the second. Our study reports a novel technique for the on-line identification of these functional components during M1 tumors resection. It reports for the first time the potential plastic reorganization of M1 and specifically how its functional organization is affected by a growing tumor and correlated to clinical, tumor-related factors and patient motor functional performance. It also shows for the first time that detecting the M1 functional architecture and targeting the two M1 functional components facilitates tumor resection, increasing the rate of complete tumor removal, while maintaining the patient’s functional motor capacity. Abstract Primary-Motor-Cortex (M1) hosts two functional components, at its posterior and anterior borders, being the first faster and more excitable. We developed a mapping-technique for M1 components identification and determined their functional cortical-subcortical architecture in M1 gliomas and the impact of their identification on tumor resection and motor performance. A novel advanced mapping technique was used in 102 tumors within M1 or CorticoSpinal-Tract to identify M1-two components. High-Frequency-stimulation (2–5 pulses) with an on-line qualitative and quantitative analysis of motor responses was used; the two components’ cortical/subcortical spatial distribution correlated to clinical, tumor-related factor and patients’ motor outcome; a cohort treated with standard-mapping was used for comparison. The two functional components were always identified on-line; in tumors not affecting M1, its functional segregation was preserved. In M1 tumors, two architectures, both preserving the two components, were disclosed: in 50%, a normal cortical/subcortical architecture emerged, while 50% revealed a distorted architecture with loss of anatomical reference and somatotopy, not associated with tumor histo-molecular features or volume, but with a previous treatment. Motor performance was maintained, suggesting functional compensation. By preserving the highest and resecting the lowest excitability component, the complete-resection increased with low morbidity. The real-time identification of two M1 functional components and the preservation of the highest excitability one increases safe resection, revealing M1 plasticity potentials.
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