title: Cortical networks of procedural learning: evidence from cerebellar damage.
abstract: The lateral cerebellum plays a critical role in procedural learning that goes beyond the strict motor control functions attributed to it. Patients with cerebellar damage show marked impairment in the acquisition of procedures, as revealed by their performance on the serial reaction time task (SRTT). Here we present the case of a patient affected by ischemic damage involving the left cerebellum who showed a selective deficit in procedural learning while performing the SRTT with the left hand. The deficit recovered when the cortical excitability of an extensive network involving both cerebellar hemispheres and the dorsolateral prefrontal cortex (DLPFC) was decreased by low-frequency repetitive transcranial magnetic stimulation (rTMS). Although inhibition of the right DLPFC or a control fronto-parietal region did not modify the patient's performance, inhibition of the right (unaffected) cerebellum and the left DLPFC markedly improved task performance. These findings could be explained by the modulation of a set of inhibitory and excitatory connections between the lateral cerebellum and the contralateral prefrontal area induced by rTMS. The presence of left cerebellar damage is likely associated with a reduced excitatory drive from sub-cortical left cerebellar nuclei towards the right DLPFC, causing reduced excitability of the right DLPFC and, conversely, unbalanced activation of the left DLPFC. Inhibition of the left DLPFC would reduce the unbalancing of cortical activation, thus explaining the observed selective recovery of procedural memory.
authors.affiliation: Laboratorio di Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy. s.torriero@libero.it
authors.forename: Sara
authors.initials: S
authors.lastname: Torriero
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Oliveri
authors.forename: Giacomo
authors.initials: G
authors.lastname: Koch
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Gerfo
authors.forename: Silvia
authors.initials: S
authors.lastname: Salerno
authors.forename: Laura
authors.initials: L
authors.lastname: Petrosini
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D002526:Cerebellar Diseases / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology*; D003627:Data Interpretation, Statistical; D006801:Humans; D007858:Learning / Q000502:physiology*; D008297:Male; D008568:Memory / Q000502:physiology; D008570:Memory, Short-Term / Q000502:physiology; D009146:Music / Q000523:psychology; D009415:Nerve Net / Q000502:physiology* / Q000503:physiopathology*; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000502:physiology / Q000503:physiopathology; D011597:Psychomotor Performance / Q000502:physiology; D011930:Reaction Time / Q000502:physiology; D050781:Transcranial Magnetic Stimulation