Short-Interval Intracortical Facilitation Improves Efficacy in nTMS Motor Mapping of Lower Extremity Muscle Representations in Patients with Supra-Tentorial Brain Tumors

Navigated transcranial magnetic stimulation (nTMS) is increasingly used for mapping of motor function prior to surgery in patients harboring motor-eloquent brain lesions. To date, single-pulse nTMS (sp-nTMS) has been predominantly used for this purpose, but novel paired-pulse nTMS (pp-nTMS) with biphasic pulse application has been made available recently. The purpose of this study was to systematically evaluate pp-nTMS with biphasic pulses in comparison to conventionally used sp-nTMS for preoperative motor mapping of lower extremity (lE) muscle representations. Thirty-nine patients (mean age: 56.3 ± 13.5 years, 69.2% males) harboring motor-eloquent brain lesions of different entity underwent motor mapping of lE muscle representations in lesion-affected hemispheres and nTMS-based tractography of the corticospinal tract (CST) using data from sp-nTMS and pp-nTMS with biphasic pulses, respectively. Compared to sp-nTMS, pp-nTMS enabled motor mapping with lower stimulation intensities (61.8 ± 13.8% versus 50.7 ± 11.6% of maximum stimulator output, p < 0.0001), and it provided reliable motor maps even in the most demanding cases where sp-nTMS failed (pp-nTMS was able to provide a motor map in five patients in whom sp-nTMS did not provide any motor-positive points, and pp-nTMS was the only modality to provide a motor map in one patient who also did not show motor-positive points during intraoperative stimulation). Fiber volumes of the tracked CST were slightly higher when motor maps of pp-nTMS were used, and CST tracking using pp-nTMS data was also possible in the five patients in whom sp-nTMS failed. In conclusion, application of pp-nTMS with biphasic pulses enables preoperative motor mapping of lE muscle representations even in the most challenging patients in whom the motor system is at high risk due to lesion location or resection.

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Intraoperative mapping of pre-central motor cortex and subcortex: a proposal for supplemental cortical and novel subcortical maps to Penfield’s motor homunculus

Brain Structure and Function ◽

10.1007/s00429-021-02274-z ◽

2021 ◽

Author(s):

Prajwal Ghimire ◽

Jose Pedro Lavrador ◽

Asfand Baig Mirza ◽

Noemia Pereira ◽

Hannah Keeble ◽

...

Keyword(s):

Brain Mapping ◽

Retrospective Cohort ◽

Corticospinal Tract ◽

Brain Lesions ◽

Body Parts ◽

Single Institution ◽

Motor Representation ◽

Motor Mapping ◽

Subcortical Stimulation ◽

Motor Maps

AbstractPenfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map. We believe this knowledge is essential for safe surgery in patients with eloquent brain lesions. A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. One hundred and eighty consecutive patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield’s motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.

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Intraoperative mapping of pre-central motor cortex and subcortex: a proposal for supplemental cortical and novel subcortical maps to Penfield’s motor homunculus

10.21203/rs.3.rs-115348/v1 ◽

2020 ◽

Author(s):

Prajwal Ghimire ◽

Jose Lavrador ◽

Asfand Mirza ◽

Noemia Pereira ◽

Hannah Keeble ◽

...

Keyword(s):

Brain Mapping ◽

Retrospective Cohort ◽

Corticospinal Tract ◽

Brain Lesions ◽

Body Parts ◽

Single Institution ◽

Motor Representation ◽

Motor Mapping ◽

Subcortical Stimulation ◽

Motor Maps

Abstract Introduction: Penfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map that are accurate and essential for safe surgery in patients with eloquent brain lesions. Materials and methods: A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. Results: 180 patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield’s motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. Conclusion: The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.

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Low Threshold Monopolar Motor Mapping for Resection of Motor-eloquent Brain Lesions in Children and Adolescents

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1383753 ◽

2014 ◽

Vol 75 (S 02) ◽

Author(s):

P. Schucht ◽

K. Seidel ◽

M. Murek ◽

L. Stieglitz ◽

N. Urwyler ◽

...

Keyword(s):

Children And Adolescents ◽

Brain Lesions ◽

Motor Mapping ◽

Low Threshold

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Analysis of Lower Extremity Muscle Strength by the Classification of the Event Characteristics in Secondary School Athletes

Journal of educational Research Institute ◽

10.15564/jeju.2020.02.22.1.135 ◽

2020 ◽

Vol 22 (1) ◽

pp. 135-146

Author(s):

Somi Yun ◽

Kihoon Lim ◽

Chulhyeong Park

Keyword(s):

Muscle Strength ◽

Secondary School ◽

Lower Extremity ◽

Lower Extremity Muscle

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Effects of Sit Up Exercise using Gym Ball Unit on Lower Extremity Muscle Strength

The Journal of Korean Academy of Physical Therapy Science ◽

10.26862/jkpts.2018.09.25.2.35 ◽

2018 ◽

Vol 25 (2) ◽

pp. 35-46

Author(s):

Jung-Ae An ◽

Jin Lee ◽

Hyun-Soo Bang

Keyword(s):

Muscle Strength ◽

Lower Extremity ◽

Lower Extremity Muscle

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Machine Learning for Rapid Estimation of Lower Extremity Muscle and Joint Loading during Activities of Daily Living

Journal of Biomechanics ◽

10.1016/j.jbiomech.2021.110439 ◽

2021 ◽

pp. 110439

Author(s):

William S. Burton ◽

Casey A. Myers ◽

Paul J. Rullkoetter

Keyword(s):

Machine Learning ◽

Lower Extremity ◽

Activities Of Daily Living ◽

Daily Living ◽

Joint Loading ◽

Rapid Estimation ◽

Lower Extremity Muscle

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Lower extremity muscle power – A critical determinant of physical function in aging and multiple sclerosis

Experimental Gerontology ◽

10.1016/j.exger.2021.111347 ◽

2021 ◽

pp. 111347

Author(s):

Rasmus A.W. Stagsted ◽

Cintia Ramari ◽

Anders G. Skjerbaek ◽

Cecilie Thrue ◽

Ulrik Dalgas ◽

...

Keyword(s):

Multiple Sclerosis ◽

Lower Extremity ◽

Physical Function ◽

Muscle Power ◽

Critical Determinant ◽

Lower Extremity Muscle

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Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults

European Review of Aging and Physical Activity ◽

10.1186/s11556-021-00260-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Chisato Hayashi ◽

Soshiro Ogata ◽

Tadashi Okano ◽

Hiromitsu Toyoda ◽

Sonoe Mashino

Keyword(s):

Older Adults ◽

Muscle Strength ◽

Physical Exercise ◽

Lower Extremity ◽

Physical Function ◽

Community Dwelling ◽

Group Exercise ◽

Community Based ◽

Lower Extremity Muscle

Abstract Background The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. Methods We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate. Results A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. Discussion Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. Conclusion Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

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Six-minute walk distance predicts hospitalization in elderly peritoneal dialysis patients: a single-center prospective cohort study

Renal Replacement Therapy ◽

10.1186/s41100-021-00354-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hiroki Yabe ◽

Yuto Imoto ◽

Ayaka Onoyama ◽

Sayaka Ito ◽

Kenichi Kono ◽

...

Keyword(s):

Cohort Study ◽

Peritoneal Dialysis ◽

Muscle Strength ◽

Lower Extremity ◽

Exercise Intolerance ◽

Single Center ◽

Walk Distance ◽

Walk Speed ◽

Lower Extremity Muscle

Abstract Background The risk of adverse events associated with peritoneal dialysis (PD) in elderly patients has not been thoroughly investigated. The purpose of this study was to assess the association between physical function and hospitalization in elderly PD patients. Methods This is a single-center prospective observational cohort study. Thirty-three aged patients (74.8 ± 5.9 years) participated in a 6-min walk distance, short physical performance battery (SPPB), lower extremity muscle strength, and 10-m walk speed. All subjects were followed until hospitalization to the end of the follow-up period. Results The 6-min walk distance was 332 ± 112.5 m; SPPB was 11 (8.3–12) points; the lower extremity muscle strength was 36.6 ± 9.6%; 10-m walk speed was 1.1± 0.2 m/s. During the follow-up, 19 patients (57.5%) were hospitalized. In the Kaplan-Meier survival analysis and log-rank test, a lower 6-min walk distance and PD vintage were significantly associated with hospitalization (p<0.05). After adjustment for PD vintage in Cox proportional analysis, the 6-min walk distance remained associated with hospitalization (95% confidence interval, 0.98–0.99). Conclusion Lower exercise tolerance assessed by the 6-min walk distance was significantly associated with hospitalization in elderly PD patients. Our findings indicate that measurement and intervention of exercise intolerance are essential to predict the clinical outcomes of elderly PD patients. Trial registration This study was prospectively registered at inception in the UMIN Clinical Trials Registry under identification number UMIN000038405.

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