title: Brain Activation Evoked by Sensory Stimulation in Patients with Spinal Cord Injury : Functional Magnetic Resonance Imaging Correlations with Clinical Features.
abstract: OBJECTIVE
  The purpose of this study is to determine whether the changes of contralateral sensorimotor cortical activation on functional magnetic resonance imaging (fMRI) can predict the neurological outcome among spinal cord injury (SCI) patients when the great toes are stimulated without notice.
  
  
  METHODS
  This study enrolled a total of 49 patients with SCI and investigated each patient's preoperative fMRI, postoperative fMRI, American Spinal Injury Association (ASIA) score, and neuropathic pain occurrence. Patients were classified into 3 groups according to the change of blood oxygenation level dependent (BOLD) response on perioperative fMRI during proprioceptive stimulation with repetitive passive toe movements : 1) patients with a response of contralateral sensorimotor cortical activation in fMRI were categorized; 2) patients with a response in other regions; and 3) patients with no response. Correlation between the result of fMRI and each parameter was analyzed.
  
  
  RESULTS
  In fMRI data, ASIA score was likely to show greater improvement in patients in group A compared to those belonging to group B or C (p<0.001). No statistical significance was observed between the result of fMRI and neuropathic pain (p=0.709). However, increase in neuropathic pain in response to the signal change of the ipsilateral frontal lobe on fMRI was statistically significant (p=0.030).
  
  
  CONCLUSIONS
  When there was change of BOLD response at the contralateral sensorimotor cortex on perioperative fMRI after surgery, relief of neurological symptoms was highly likely for traumatic SCI patients. In addition, development of neuropathic pain was likely to occur when there was change of BOLD response at ipsilateral frontal lobe.
authors.affiliation: Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea.
authors.forename: Jun Ki
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Guro Cham Teun Teun Hospital, Seoul, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea.
authors.forename: Hyung-Chun
authors.initials: HC
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Yoon
keywords: Functional MRI; Neuropathic pain; Proprioceptive; Spinal cord injury