title: The role of multiple contralesional motor areas for complex hand movements after internal capsular lesion.
abstract: Imaging techniques document enhanced activity in multiple motor areas of the damaged and contralesional (intact) hemisphere (CON-H) after stroke. In the subacute stage, increased activity within motor areas in the CON-H during simple movements of the affected hand has been shown to correlate with poorer motor outcome. For those patients in the chronic stage who recovered well, the functional relevance of an increased activation within the CON-H is unclear. Using trains of repetitive transcranial magnetic stimulation (TMS) during performance of complex finger movements, we tested the behavioral relevance of regional functional magnetic resonance imaging (fMRI) activation within the CON-H for sequential finger movement performance of the recovered hand in seven patients who had experienced a subcortical stroke. TMS was navigated over fMRI activation maxima within anatomically preselected regions of the CON-H, and effects were compared with those of healthy controls. Stimulation over the dorsal premotor cortex (dPMC), the primary motor cortex (M1), and the superior parietal lobe (SPL) resulted in significant interference with recovered performance in patients. Interference with the dPMC and M1 induced timing errors only, SPL stimulation caused both timing and accuracy deficits. The present results argue for a persistent beneficial role of the dPMC, M1, and SPL of the CON-H on some aspects of effectively recovered complex motor behavior after subcortical stroke.
authors.affiliation: Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, D-72076 Tuebingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Lotze
authors.forename: Jochen
authors.initials: J
authors.lastname: Markert
authors.forename: Paul
authors.initials: P
authors.lastname: Sauseng
authors.forename: Julia
authors.initials: J
authors.lastname: Hoppe
authors.forename: Christian
authors.initials: C
authors.lastname: Plewnia
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
mesh_terms: D000368:Aged; D005385:Fingers / Q000294:innervation*; D007839:Functional Laterality; D006225:Hand / Q000294:innervation*; D006429:Hemiplegia / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009044:Motor Cortex / Q000503:physiopathology*