title: Lateralization of cortical negative motor areas.
abstract: The lateral and mesial aspects of the central and frontal cortex were studied by direct electrical stimulation of the cortex in epilepsy surgery candidates in order to determine the localization of unilateral and bilateral negative motor responses.
  
  
  
  Results of electrical cortical stimulation were examined in epilepsy surgery candidates in whom invasive electrodes were implanted. The exact localization of subdural electrodes was defined by fusion of 3-dimensional reconstructed MRI and CT images in 13 patients and by analysis of plane skull X-rays and intraoperative visual localization of the electrodes in another 7 patients.
  
  
  
  Results of electrical stimulation of the cortex were evaluated in a total of 128 patients in whom invasive electrodes were implanted for planning resective epilepsy surgery. Twenty patients, in whom negative motor responses were obtained, were included in the study. Bilateral upper limb negative motor responses were more often elicited from stimulation of the mesial frontal cortex whereas stimulation of the lateral central cortex leads to contralateral upper limb negative motor responses (p<0.0001). Bilateral negative motor responses were exclusively found in the superior frontal gyrus whereas contralateral negative motor responses localized predominantly in the anterior part of the precentral gyrus (p<0.0001).
  
  
  
  Exact localization using 3-D fusion methods revealed that negative motor areas are widely distributed throughout the precentral gyrus and the mesial fronto-central cortex showing functional differences with regard to unilateral and bilateral upper limb representation.
  
  
  
  The lateral fronto-central negative motor area serves predominantly contralateral upper limb motor control whereas the mesial frontal negative motor area represents bilateral upper limb movement control.
authors: Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Munich, Germany.
authors: Ingo
authors: I
authors: Borggraefe
authors: Epilepsy Center, Department of Neurology, University of Munich, Germany.
authors: Claudia B
authors: CB
authors: Catarino
authors: Epilepsy Center, Department of Neurology, University of Munich, Germany.
authors: Jan
authors: J
authors: Rémi
authors: Epilepsy Center, Department of Neurology, University of Munich, Germany.
authors: Christian
authors: C
authors: Vollmar
authors: Department of Neurosurgery, University of Munich, Germany.
authors: Aurelia
authors: A
authors: Peraud
authors: Department of Neurosurgery, University of Munich, Germany.
authors: Peter A
authors: PA
authors: Winkler
authors: Epilepsy Center, Department of Neurology, University of Munich, Germany. Electronic address: noa@med.uni-muenchen.de.
authors: Soheyl
authors: S
authors: Noachtar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D046690:Deep Brain Stimulation; D004827:Epilepsy / Q000503:physiopathology*; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009068:Movement; D049268:Positron-Emission Tomography; D034941:Upper Extremity / Q000294:innervation
keywords: Cortical electrical stimulation; Motor planning; Negative motor areas