title: Different cerebral plasticity of intrinsic and extrinsic hand muscles after peripheral neurotization in a patient with brachial plexus injury: A TMS and fMRI study.
abstract: Contralateral C7 (CC7) neurotization has been an important approach for brachial plexus injury (BPI). Patients can achieve relatively good grasping function driven by the proximal extrinsic hand muscle (flexor digitorum, FD) after CC7 neurotization, whereas the thumb opposition function driven by the distal intrinsic muscle (abductor pollicis brevis, APB) is poor. The present study aimed to investigate the brain reorganization patterns of the recovery processes of intrinsic and extrinsic hand functions after repairing the median nerve by CC7 neurotization. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) were used to evaluate the cerebral plasticity in one BPI patient after CC7 neurotization. After the CC7 neurotization, the patient showed improvements in the paralyzed hand. Combination of TMS and fMRI investigations demonstrated different cortical reshaping patterns of APB and FD. It was also found that the activated cortical areas of FD were located in bilateral motor cortices, but the area of APB was only located in ipsilateral motor cortex. The cerebral plasticity procedure appeared to be different in the gross and fine motor function recovery processes. It provided a new perspective into the cerebral plasticity induced by CC7 neurotization.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
authors.forename: Tie
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
authors.forename: Xu-Yun
authors.initials: XY
authors.lastname: Hua
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
authors.forename: Mou-Xiong
authors.initials: MX
authors.lastname: Zheng
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Wang
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
authors.forename: Jian-Guang
authors.initials: JG
authors.lastname: Xu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Gu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China. Electronic address: wendongxu@fudan.edu.cn.
authors.forename: Wen-Dong
authors.initials: WD
authors.lastname: Xu
mesh_terms: D001917:Brachial Plexus / Q000293:injuries*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D006225:Hand / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008475:Median Nerve / Q000601:surgery; D018482:Muscle, Skeletal / Q000294:innervation* / Q000503:physiopathology; D009416:Nerve Regeneration; D016067:Nerve Transfer; D009473:Neuronal Plasticity; D010243:Paralysis / Q000503:physiopathology* / Q000601:surgery; D050781:Transcranial Magnetic Stimulation; D014459:Ulnar Nerve / Q000601:surgery
keywords: Brachial plexus injury; Cerebral plasticity; Motor cortex; Neurophysiology and neuroimaging; Peripheral neurotization