Individual variations of the human corticospinal tract and its hand-related motor fibers using diffusion MRI tractography

The corticospinal tract (CST) is one of the most well-studied tracts in human neuroanatomy. Its clinical significance can be demonstrated in many notable traumatic conditions and diseases such as stroke, spinal cord injury (SCI) or amyotrophic lateral sclerosis (ALS). With the advent of diffusion MRI and tractography the computational representation of the human CST in a 3D model became available. However, the representation of the entire CST and, specifically, the hand motor area has remained elusive. In this paper we proposed a novel method, using manually-drawn ROIs based on robustly identifiable neuroanatomic structures to delineate the entire CST and isolate its hand motor representation as well as to estimate their variability and generate a database of their volume, length and biophysical parameters. Using 37 healthy human subjects we performed a qualitative and quantitative analysis of the CST and the hand-related motor fiber tracts (HMFTs). Finally, we have created variability heatmaps from 37 subjects for both the aforementioned tracts, which could be utilized as reference for clinicians to explore neuropathology in both trauma and disease states.

Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis

Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transesophageal echocardiography. The patient underwent percutaneous device closure of patent foramen ovale after alternately repeated paresis of both hands despite antiplatelet treatment. This case suggests that ischemic stroke affecting the cortical knob area, albeit extremely rare, may recur due to a patent foramen ovale, and it necessitates complete investigation, including transesophageal echocardiography, to identify possible embolic sources.

Anodal transcranial direct current stimulation of the motor cortex induces opposite modulation of reciprocal inhibition in wrist extensor and flexor

Transcranial direct current stimulation (tDCS) is used as a noninvasive tool to modulate brain excitability in humans. Recently, several studies have demonstrated that tDCS applied over the motor cortex also modulates spinal neural network excitability and therefore can be used to explore the corticospinal control acting on spinal neurons. Previously, we showed that reciprocal inhibition directed to wrist flexor motoneurons is enhanced during contralateral anodal tDCS, but it is likely that the corticospinal control acting on spinal networks controlling wrist flexors and extensors is not similar. The primary aim of the study was to explore the effects of anodal tDCS on reciprocal inhibition directed to wrist extensor motoneurons. To further examine the supraspinal control acting on the reciprocal inhibition between wrist flexors and extensors, we also explored the effects of the tDCS applied to the ipsilateral hand motor area. In healthy volunteers, we tested the effects induced by sham and anodal tDCS on reciprocal inhibition pathways innervating wrist muscles. Reciprocal inhibition directed from flexor to extensor muscles and the reverse situation, i.e., reciprocal inhibition, directed from extensors to flexors were studied in parallel with the H reflex technique. Our main finding was that contralateral anodal tDCS induces opposing effects on reciprocal inhibition: it decreases reciprocal inhibition directed from flexors to extensors, but it increases reciprocal inhibition directed from extensors to flexors. The functional result of these opposite effects on reciprocal inhibition seems to favor wrist extension excitability, suggesting an asymmetric descending control onto the interneurons that mediate reciprocal inhibition.

The strength of the corticospinal coherence depends on the predictability of modulated isometric forces

Isometric compensation of predictably frequency-modulated low forces is associated with corticomuscular coherence (CMC) in beta and low gamma range. It remains unclear how the CMC is influenced by unpredictably modulated forces, which create a mismatch between expected and actual sensory feedback. We recorded electroencephalography from the contralateral hand motor area, electromyography (EMG), and the motor performance of 16 subjects during a visuomotor task in which they had to isometrically compensate target forces at 8% of the maximum voluntary contraction with their right index finger. The modulated forces were presented with predictable or unpredictable frequencies. We calculated the CMC, the cortical motor alpha-, beta-, and gamma-range spectral powers (SP), and the task-related desynchronization (TRD), as well as the EMG SP and the performance. We found that in the unpredictable condition the CMC was significantly lower and associated with lower cortical motor SP, stronger TRD, higher EMG SP, and worse performance. The findings suggest that due to the mismatch between predicted and actual sensory feedback leading to higher computational load and less stationary motor state, the unpredictable modulation of the force leads to a decrease in corticospinal synchrony, an increase in cortical and muscle activation, and a worse performance.