Subcortical electrostimulation to identify network subserving motor control

Authors

  • Philippe Schucht,

    1. Department of Neurosurgery, Bern University Hospital, Bern, Switzerland
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  • Sylvie Moritz-Gasser,

    1. Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
    2. Team “Brain Plasticity, Stem Cells and Glial Tumors”, Institute for Neuroscience of Montpellier, INSERM U1051, Hospital Saint Eloi, CHU Montpellier, Montpellier, France
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  • Guillaume Herbet,

    1. Team “Brain Plasticity, Stem Cells and Glial Tumors”, Institute for Neuroscience of Montpellier, INSERM U1051, Hospital Saint Eloi, CHU Montpellier, Montpellier, France
    2. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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  • Andreas Raabe,

    1. Department of Neurosurgery, Bern University Hospital, Bern, Switzerland
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  • Hugues Duffau

    Corresponding author
    1. Team “Brain Plasticity, Stem Cells and Glial Tumors”, Institute for Neuroscience of Montpellier, INSERM U1051, Hospital Saint Eloi, CHU Montpellier, Montpellier, France
    2. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
    • Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier, France. E-mail: h-duffau@chu-montpellier.fr

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Abstract

Objectives: Recent anatomical–functional studies have transformed our understanding of cerebral motor control away from a hierarchical structure and toward parallel and interconnected specialized circuits. Subcortical electrical stimulation during awake surgery provides a unique opportunity to identify white matter tracts involved in motor control. For the first time, this study reports the findings on motor modulatory responses evoked by subcortical stimulation and investigates the cortico-subcortical connectivity of cerebral motor control. Experimental design: Twenty-one selected patients were operated while awake for frontal, insular, and parietal diffuse low-grade gliomas. Subcortical electrostimulation mapping was used to search for interference with voluntary movements. The corresponding stimulation sites were localized on brain schemas using the anterior and posterior commissures method. Principal observations: Subcortical negative motor responses were evoked in 20/21 patients, whereas acceleration of voluntary movements and positive motor responses were observed in three and five patients, respectively. The majority of the stimulation sites were detected rostral of the corticospinal tract near the vertical anterior-commissural line, and additional sites were seen in the frontal and parietal white matter. Conclusions: The diverse interferences with motor function resulting in inhibition and acceleration imply a modulatory influence of the detected fiber network. The subcortical stimulation sites were distributed veil-like, anterior to the primary motor fibers, suggesting descending pathways originating from premotor areas known for negative motor response characteristics. Further stimulation sites in the parietal white matter as well as in the anterior arm of the internal capsule indicate a large-scale fronto-parietal motor control network. Hum Brain Mapp 34:3023–3030, 2013. © 2012 Wiley Periodicals, Inc.

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