title: The cortical topography of human anorectal musculature.
abstract: OBJECTIVE
  The muscles of the anorectum are important in the volitional control of continence, yet virtually no information exists on their cortical representation in humans.
  
  
  METHODS
  Topographic cortical mapping of both cerebral hemispheres was performed in 9 healthy subjects by applying suprathreshold transcranial magnetic stimulation to individual points on a scalp grid centered over the vertex and then recording the electromyographic responses from the external anal sphincter, rectum, and tibialis anterior muscles.
  
  
  RESULTS
  Cortically evoked anal and rectal response latencies were similar (20.2 +/- 1.7 and 19.8 +/- 1.5 milliseconds, respectively) and were shorter than those from the anterior tibialis muscle (right, 29.7 +/- 2.3 milliseconds; left, 29.9 +/- 1.8 milliseconds; P < 0.0005). Cortical mapping showed that the anal responses were bilaterally represented on the superior motor cortex (Brodmann area 4) of both cerebral hemispheres; a similar topography was found for the rectal responses. By comparison, the tibialis responses showed predominantly contralateral medial motor cortex representation. Subtle but consistent differences in the degree of bilateral hemispheric representation were also apparent both between and within individuals for the anal responses and to a lesser extent for the rectal responses.
  
  
  CONCLUSIONS
  The anorectal musculature has bilateral motor cortex representation with similar topography, but there is intersubject variation in the degree of symmetry.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: G K
authors.initials: GK
authors.lastname: Turnbull
authors.forename: S
authors.initials: S
authors.lastname: Hamdy
authors.forename: Q
authors.initials: Q
authors.lastname: Aziz
authors.forename: K D
authors.initials: KD
authors.lastname: Singh
authors.forename: D G
authors.initials: DG
authors.lastname: Thompson
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000502:physiology*; D001931:Brain Mapping; D004576:Electromyography; D005260:Female; D006801:Humans; D007866:Leg; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D009130:Muscle, Smooth / Q000502:physiology*; D010812:Physical Stimulation; D011930:Reaction Time / Q000502:physiology; D012007:Rectum / Q000502:physiology*; D015203:Reproducibility of Results; D012535:Scalp / Q000502:physiology