Mapping Motor Neuroplasticity after Successful Surgical Brachial Plexus Reconstruction Using Navigated Transcranial Magnetic Stimulation (nTMS)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. nTMS Protocol
2.3. Computation of the Cortical Representation Area and Statistical Analysis
- The TMS coil stimulates the cortex area closest to the coil.
- The TMS stimulating field is similar in every location of the cortex, and there are no relevant variations in the MEPs induced by TMS.
3. Results
3.1. Patient Characteristics
3.2. Cortical Motor Area Location
3.3. Cortical Motor Area Size
4. Discussion
4.1. Limitations
4.2. Future Perspectives
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
3D Convex Hull | 2D Convex Hull | 2D Voronoi | 2D Alpha | ||||||
---|---|---|---|---|---|---|---|---|---|
Category | ID | Left | Right | Left | Right | Left | Right | Left | Right |
volunteer | 1 | 197 | 362 | 192.9 | 339.8 | 144.7 | 350.4 | 123.5 | 279.1 |
volunteer | 2 | 682.6 | 45 | 644.6 | 36.9 | 510.3 | 26.1 | 571.8 | 27.7 |
volunteer | 3 | 243 | 132 | 239.1 | 119.5491 | 70.3 | 82.6644 | 170.1 | 88.5177 |
volunteer | 4 | 227 | 162 | 220.2 | 110.3 | 106.9 | 79.7 | 179.7 | 99.4 |
volunteer | 5 | 1643 | 361 | 1568.5 | 332.4 | 974 | 193.3 | 1260.5 | 279.4 |
volunteer | 6 | 299 | 433 | 273.4 | 369.9 | 186.2 | 289.9 | 203.8 | 316 |
volunteer | 7 | 349 | 378 | 337.2 | 350.4 | 139.3 | 132.8 | 296.6 | 181.9 |
volunteer | 8 | 380 | 1376 | 370.5 | 1083.5 | 174.1 | 1284.6 | 239.2 | 934.5 |
volunteer | 9 | 183 | 415 | 181.8 | 402.3 | 97.7 | 308 | 100 | 300.9 |
volunteer | 10 | 526 | 384 | 502.3 | 358.9 | 425.1 | 225.6 | 380.9 | 283.7 |
mean | 473.0 | 404.8 | 453.1 | 350.4 | 282.9 | 297.3 | 352.6 | 279.1 | |
Category | ID | unaffected | affected | unaffected | affected | unaffected | affected | unaffected | affected |
patient | 1 | 536.9 | 1639 | 525.7 | 1491.7 | 270 | 399.2 | 436.2 | 1105.3 |
patient | 2 | 1157.3 | 194 | 1132.2 | 190.5 | 278.9 | 86 | 952.8 | 167.5 |
patient | 3 | 177 | 1013 | 125 | 953.5 | 177.2 | 1252.2 | 103.6 | 686 |
patient | 5 | 290 | 72 | 286.4 | 63.2 | 174.8 | 65.5 | 260.2 | 45.6 |
patient | 6 | 344.8 | 449.8 | 236.5 | 435.2 | 119.1 | 394.7 | 195.9 | 381.5 |
patient | 7 | 359.8 | 735.2 | 340.4 | 620.4 | 156.6 | 459.3 | 315.6 | 510.7 |
patient | 8 | 143 | 451 | 134.6 | 441.8 | 103.8 | 126.7 | 123.4 | 352 |
mean | 429.8 | 650.6 | 397.3 | 599.5 | 182.9 | 397.7 | 341.1 | 464.1 |
2D Interpol | SD ABV | SD BLW | SD Tot | ||||||
---|---|---|---|---|---|---|---|---|---|
Category | ID | Left | Right | Left | Right | Left | Right | Left | Right |
volunteer | 1 | 123.3 | 276.6 | −0.53 | −3.94 | −1.14 | −2.41 | −1.44 | −2.55 |
volunteer | 2 | 640.6 | 38.1 | −2.12 | −0.70 | −2.26 | −2.89 | −2.24 | −2.91 |
volunteer | 3 | 200.5 | 94.284 | −0.81 | −5.29 | −2.19 | −2.84 | −2.22 | −2.90 |
volunteer | 4 | 199.9 | 104 | −1.52 | −1.30 | −2.01 | −2.82 | −2.05 | −2.88 |
volunteer | 5 | 1276.8 | 283.3 | −1.17 | −3.54 | −1.60 | −2.14 | −1.62 | −2.17 |
volunteer | 6 | 206.9 | 332.7 | −1.46 | −7.29 | −2.27 | −2.50 | −2.37 | −2.60 |
volunteer | 7 | 307.5 | 196.6 | −0.65 | −2.08 | −2.11 | −2.75 | −2.16 | −2.79 |
volunteer | 8 | 252.4 | 933.4 | −0.20 | −1.66 | −1.47 | 1.17 | −1.51 | −2.10 |
volunteer | 9 | 98.7 | 312 | −0.21 | −1.51 | −1.71 | −2.89 | −1.71 | −3.03 |
volunteer | 10 | 372.3 | 279.4 | −1.34 | −0.69 | −2.61 | −2.93 | −2.89 | −3.11 |
mean | 367.9 | 285.0 | −1.00 | −2.80 | −1.94 | −2.30 | −2.02 | −2.70 | |
Category | ID | unaffected | affected | unaffected | affected | unaffected | affected | unaffected | affected |
patient | 1 | 470.7 | 1274.2 | −0.37 | −1.38 | −1.14 | −3.06 | −1.67 | −3.07 |
patient | 2 | 1109.9 | 194 | −0.39 | −0.48 | −1.28 | −2.28 | −1.28 | −2.35 |
patient | 3 | 102.7 | 695 | −2.17 | −1.66 | −3.09 | −1.40 | −3.13 | −1.44 |
patient | 5 | 277.8 | 50.8 | −0.29 | −1.38 | −2.38 | −2.31 | −2.46 | −2.36 |
patient | 6 | 232.3 | 385 | −0.49 | −0.98 | −1.60 | −1.50 | −1.62 | −1.58 |
patient | 7 | 324.6 | 527.1 | −1.32 | −1.19 | −1.08 | −1.73 | −1.09 | −1.79 |
patient | 8 | 117.7 | 363.1 | −1.54 | −0.49 | −3.13 | −2.78 | −3.18 | −2.80 |
mean | 376.5 | 498.5 | −0.94 | −1.08 | −1.96 | −2.15 | −2.06 | −2.20 |
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Volunteer | Sex | Age | Handedness | RMT, Left | Total Number of Stimulations, Left | Positive Motor Responses, Left | RMT, Right | Total Number of Stimulations, Right | Positive Motor Responses, Right |
---|---|---|---|---|---|---|---|---|---|
volunteer 1 | f | 29 | ambidextrous | 33% | 273 | 33 | 37% | 226 | 33 |
volunteer 2 | f | 41 | right | 42% | 173 | 32 | 32% | 240 | 9 |
volunteer 3 | m | 31 | right | 36% | 373 | 14 | 35% | 398 | 19 |
volunteer 4 | f | 23 | right | 31% | 326 | 23 | 34% | 327 | 15 |
volunteer 5 | m | 25 | right | 68% | 295 | 73 | 51% | 339 | 34 |
volunteer 6 | f | 24 | left | 29% | 297 | 31 | 32% | 258 | 30 |
volunteer 7 | f | 33 | right | 34% | 368 | 23 | 32% | 331 | 22 |
volunteer 8 | m | 24 | right | 38% | 258 | 27 | 60% | 175 | 54 |
volunteer 9 | f | 25 | right | 38% | 199 | 14 | 45% | 205 | 38 |
volunteer 10 | f | 24 | right | 49% | 256 | 70 | 48% | 261 | 44 |
sum | 2818 | 340 | 2760 | 298 | |||||
mean | 27.9 | 40% | 41% | ||||||
median | 37% | 36% |
Patient | Sex | Age | Age at Accident | Handedness | Affected Hemisphere | Associated TBI | Detailed Procedure | Type of Reconstruction | RMT of Affected Hemisphere | Total Number of Stimuli on Affected Hemisphere | Positive Motor Responses on Affected Hemisphere | RMT of Unaffected Hemisphere | Total Number of Stimuli on Unaffected Hemisphere | Positive Motor Responses on Unaffected Hemisphere |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
patient 1 | m | 52 | 45 | right | right | yes | Oberlin transfer | transfer | 37% | 184 | 20 | 59% | 172 | 25 |
patient 2 | m | 29 | 25 | right | right | yes | phrenic nerve on biceps branch of MC + C5 on brachial branch of MC | combination | 36% | 184 | 19 | 49% | 256 | 18 |
patient 3 | f | 41 | 32 | right | left | yes | phrenic nerve on MC | transfer | 84% | 77 | 32 | 99% | 74 | 8 |
patient 4 | m | 27 | 17 | right | left | yes | neurolysis | neurolysis | ||||||
patient 5 | f | 38 | 31 | right | left | no | C5 on MC + pectoral nerve on MC | combination | 44% | 229 | 10 | 48% | 212 | 31 |
patient 6 | m | 33 | 25 | right | left | no | lateral fascicle on MC | anatomical reconstruction | 37% | 269 | 42 | 35% | 225 | 12 |
patient 7 | m | 25 | 18 | right | left | no | C6 on MC | anatomical reconstruction | 32% | 313 | 41 | 39% | 285 | 23 |
patient 8 | m | 36 | 26 | right | left | yes | lateral fascicle on MC | anatomical reconstruction | 60% | 306 | 21 | 51% | 354 | 29 |
sum | 1562 | 185 | 1578 | 146 | ||||||||||
mean | 35.1 | 47% | 54% | |||||||||||
median | 41% | 50% |
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Durner, G.; Ulrich, I.; Gerst, A.; Becker, R.; Wirtz, C.R.; Antoniadis, G.; Pedro, M.T.; Pala, A. Mapping Motor Neuroplasticity after Successful Surgical Brachial Plexus Reconstruction Using Navigated Transcranial Magnetic Stimulation (nTMS). Neurol. Int. 2024, 16, 239-252. https://doi.org/10.3390/neurolint16010016
Durner G, Ulrich I, Gerst A, Becker R, Wirtz CR, Antoniadis G, Pedro MT, Pala A. Mapping Motor Neuroplasticity after Successful Surgical Brachial Plexus Reconstruction Using Navigated Transcranial Magnetic Stimulation (nTMS). Neurology International. 2024; 16(1):239-252. https://doi.org/10.3390/neurolint16010016
Chicago/Turabian StyleDurner, Gregor, Ina Ulrich, Alexandra Gerst, Ralf Becker, Christian Rainer Wirtz, Gregor Antoniadis, Maria Teresa Pedro, and Andrej Pala. 2024. "Mapping Motor Neuroplasticity after Successful Surgical Brachial Plexus Reconstruction Using Navigated Transcranial Magnetic Stimulation (nTMS)" Neurology International 16, no. 1: 239-252. https://doi.org/10.3390/neurolint16010016