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Brain Topography

, Volume 31, Issue 2, pp 288–299 | Cite as

Reorganization of Motor Representations in Patients with Brain Lesions: A Navigated Transcranial Magnetic Stimulation Study

  • Lucia Bulubas
  • Nico Sollmann
  • Noriko Tanigawa
  • Claus Zimmer
  • Bernhard Meyer
  • Sandro M. Krieg
Original Paper

Abstract

This is an explorative study applying presurgical navigated transcranial magnetic stimulation (nTMS) to investigate the spatial distributions of motor sites to reveal tumor-induced brain plasticity in patients with brain tumors. We analyzed nTMS-based motor maps derived from presurgical mapping of 100 patients with motor eloquently located brain tumors (tumors in the frontal lobe, the precentral gyrus [PrG], the postcentral gyrus [PoG], the remaining parietal lobe, or the temporal lobe). Based on these motor maps, we systematically investigated changes in motor evoked potential (MEP) counts among 4 gyri (PrG, PoG, medial frontal gyrus, and superior frontal gyrus) between subgroups of patients according to the tumor location in order to depict the tumor’s influence on reorganization. When comparing patients with different tumor locations, high MEP counts were elicited less frequently by stimulating the PrG in patients with tumors directly affecting the PrG (p < 0.05). Still, in more than 50% of these patients, the MEP counts elicited by stimulating the PrG were higher than average, indicating robust motor representations within the primary motor cortex. In contrast, patients with PoG and parietal tumors primarily showed high MEP counts when stimulating the PoG (p < 0.10). The functional reorganization is not likely to induce a shift of motor function from the PrG to adjacent regions but rather leads to a reorganization within anatomical constraints, such as of the PoG. Thus, presurgical nTMS-based motor mapping sensitively depicted the tumor-induced plasticity of the motor cortex.

Keywords

Brain tumor Cortical mapping Motor evoked potentials Navigated transcranial magnetic stimulation Presurgical motor mapping 

Abbreviations

3D

Three-dimensional

ADM

Abductor digiti minimi muscle

ANOVA

Analysis of variance

APB

Abductor pollicis brevis muscle

BMRC

British Medical Research Council

DCS

Direct cortical stimulation

EMG

Electromyography

FCR

Flexor carpi radialis muscle

HGG

High-grade glioma

LGG

Low-grade glioma

MEP

Motor evoked potential

MFG

Middle frontal gyrus

MRI

Magnetic resonance imaging

nTMS

Navigated transcranial magnetic stimulation

PMC

Premotor cortex

PoG

Postcentral gyrus

PrG

Precentral gyrus

rMT

Resting motor threshold

SFG

Superior frontal gyrus

UE

Upper extremity

Notes

Acknowledgements

LB and NS gratefully acknowledge the support of the Graduate School’s Faculty Graduate Center of Medicine at our university. Moreover, the study was supported by grants of the Wilhelm Sander foundation.

Funding

The study was financed by institutional grants from the Department of Neurosurgery, the Section of Neuroradiology, and the Wilhelm Sander foundation.

Compliance with Ethical Standards

Conflict of interest

SK and BM are consultants for Brainlab AG (Munich, Germany). SK is a consultant for Nexstim Plc. (Helsinki, Finland). The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryKlinikum rechts der Isar, Technische Universität MünchenMunichGermany
  2. 2.TUM-Neuroimaging CenterKlinikum rechts der Isar, Technische Universität MünchenMunichGermany
  3. 3.Section of Neuroradiology, Department of RadiologyKlinikum rechts der Isar, Technische Universität MünchenMunichGermany
  4. 4.Faculty of Linguistics, Philology & PhoneticsUniversity of OxfordOxfordUK

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