Cortical motor activation patterns following hand transplantation and replantation.
We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.
Brenneis
C
C
Clinical Department of Neurology, Innsbruck Medical University, Austria. christian.brenneis@uibk.ac.at
Löscher
W N
WN
Egger
K E
KE
Benke
T
T
Schocke
M
M
Gabl
M F
MF
Wechselberger
G
G
Felber
S
S
Pechlaner
S
S
Margreiter
R
R
Piza-Katzer
H
H
Poewe
W
W
D000328:Adult; D005260:Female; D006225:Hand / Q000502:physiology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009068:Movement / Q000502:physiology; D012092:Replantation; D014184:Transplantation, Homologous