title: New type of cortical neuroplasticity after nerve repair in brachial plexus lesions.
abstract: BACKGROUND
  In brachial plexus avulsion, a recent technique connects the ending of the disrupted musculocutaneous nerve to the side of the intact phrenic nerve to regain elbow flexion. This requires the phrenic nerve to perform a new double function: independent control of breathing and elbow flexion. Neuroplastic changes associated with acquisition of double nerve functions have not yet been investigated.
  
  
  OBJECTIVE
  To evaluate neuroplastic changes associated with acquisition of double nerve functions in a monofunctional nerve (phrenic nerve).
  
  
  METHODS
  Clinical and functional magnetic resonance imaging investigations during arm movements, forced inspiration, and motor control tasks.
  
  
  METHODS
  Investigations at the Medical University of Vienna, Vienna, Austria.
  
  
  METHODS
  Three healthy control subjects, 2 patients with phrenic nerve end-to-side coaptation, and 1 control patient with C7 end-to-end coaptation (same clinical presentation but phrenic nerve unchanged).
  
  
  RESULTS
  Clinical documentation showed that both patients with phrenic nerve end-to-side coaptation were able to control the diaphragm and the biceps independently via the same phrenic nerve. In contrast to all controls, both patients with phrenic nerve end-to-side coaptation activated the cortical diaphragm areas with flexion of the diseased arm.
  
  
  CONCLUSIONS
  Our functional magnetic resonance imaging data indicate that the patient's cortical diaphragm areas reorganize in such a way that independent control of breathing and elbow flexion is possible with the same neuronal population.
authors.affiliation: Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. roland.beisteiner@meduniwien.ac.at
authors.forename: Roland
authors.initials: R
authors.lastname: Beisteiner
authors.forename: Ilse
authors.initials: I
authors.lastname: Höllinger
authors.forename: Jakob
authors.initials: J
authors.lastname: Rath
authors.forename: Moritz
authors.initials: M
authors.lastname: Wurnig
authors.forename: Markus
authors.initials: M
authors.lastname: Hilbert
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Klinger
authors.forename: Alexander
authors.initials: A
authors.lastname: Geissler
authors.forename: Florian
authors.initials: F
authors.lastname: Fischmeister
authors.forename: Christian
authors.initials: C
authors.lastname: Wöber
authors.forename: Gerhard
authors.initials: G
authors.lastname: Klösch
authors.forename: Hanno
authors.initials: H
authors.lastname: Millesi
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grisold
authors.forename: Eduard
authors.initials: E
authors.lastname: Auff
authors.forename: Robert
authors.initials: R
authors.lastname: Schmidhammer
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology*; D009416:Nerve Regeneration / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology*; D019635:Neurosurgical Procedures / Q000379:methods*; D010791:Phrenic Nerve / Q000502:physiology