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Xu W. Harnessing the uninjured hemisphere for treatment of the stroke or brain-injured patient - evolution of the contralateral C7 transfer. J Hand Surg Eur Vol 2025; 50:796-806. [PMID: 39917853 DOI: 10.1177/17531934251314640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2025]
Abstract
This article presents a comprehensive review of contralateral C7 (cC7) transfer surgery, tracing its evolution from treating brachial plexus injuries to its transfer to ipsilateral C7 transfer surgery in treating upper motor neurone injuries. The cC7 was initially postulated to restore function by replacing injured nerves at the peripheral level, but dynamic cortical reorganization has since been demonstrated post-surgery, which potentially allows harnessing of the cC7 procedure to expand the span of control of the uninjured hemisphere in conditions like hemiplegic stroke. By integrating principles of nerve regeneration and brain plasticity through phased rehabilitation programmes, published clinical results have demonstrated significant improvements in upper limb function, confirming the procedure's safety and efficacy, with donor site morbidity that is typically mild and transient. The cC7 procedure may play a major role in the future of restoring upper limb function in patients who have suffered upper motor neurone lesions.
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Affiliation(s)
- Wendong Xu
- Department of Hand Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
- Institute of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- National Clinical Key Specialty for Limb Function Reconstruction, Shanghai, China
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2
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Zhao HL, Gao Y, Yu AP, Wei YM, Shen YD, Jiang S, Qiu YQ, Yu J, Liang ZH. MRI-Based Optimization Design of the Pre-Spinal Route of Contralateral C7 Nerve Transfer for Spastic Arm Paralysis. Front Surg 2022; 9:837872. [PMID: 35846970 PMCID: PMC9276985 DOI: 10.3389/fsurg.2022.837872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The prespinal route of contralateral cervical 7 nerve transfer developed by Prof. Wendong Xu helps realize the direct anastomosis of the bilateral cervical 7 nerves. However, 20% of operations still require a nerve graft, which leads to an unfavorable prognosis. This study aims to explore the optimized prespinal route with MRI to further improve the prognosis. Methods The current study enrolled 30 patients who suffered from central spastic paralysis of an upper limb and who underwent contralateral cervical 7 nerve transfer via Prof. Xu’s prespinal route through the anterior edge of the contralateral longus colli. MRI images were used to analyze the route length, vertebral artery exposure, and contralateral cervical 7 nerve included angle. Three prespinal routes were virtually designed and analyzed. The selected optimal route was applied to another 50 patients with central spastic paralysis of an upper limb for contralateral cervical 7 nerve transfer. Results By the interventions on the 30 patients, the middle and posterior routes were shorter than the anterior route in length, but with no statistical difference between the two routes. Of 30 contralateral vertebral arteries, 26 were located at the posterior medial edge of the longus colli. The average included angles of the anterior, middle, and posterior routes were 108.02 ± 7.89°, 95.51 ± 6.52°, and 72.48 ± 4.65°, respectively. According to these data, the middle route was optimally applied to 50 patients, in whom the rate of nerve transplantation was only 4%, and no serious complications such as vertebral artery or brachial plexus injury occurred. Conclusion The low rate of nerve transplantation in 50 patients and the absence of any serious complications in these cases suggests that the middle route is the optimal one.
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Affiliation(s)
- Hua-Li Zhao
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Yun Gao
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Ai-Ping Yu
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Min Wei
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Yun-Dong Shen
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Su Jiang
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan-Qun Qiu
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
| | - Jing Yu
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Zong-Hui Liang
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
- Correspondence: Zong-Hui Liang
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3
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Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer. Neural Plast 2022; 2022:5345269. [PMID: 35342394 PMCID: PMC8956439 DOI: 10.1155/2022/5345269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/09/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
Peripheral nerve injury can lead to partial or complete loss of limb function, and nerve transfer is an effective surgical salvage for patients with these injuries. The inability of deprived cortical regions representing damaged nerves to overcome corresponding maladaptive plasticity after the reinnervation of muscle fibers and sensory receptors is thought to be correlated with lasting and unfavorable functional recovery. However, the concept of central nervous system plasticity is rarely elucidated in classical textbooks involving peripheral nerve injury, let alone peripheral nerve transfer. This article is aimed at providing a comprehensive understanding of central nervous system plasticity involving peripheral nerve injury by reviewing studies mainly in human or nonhuman primate and by highlighting the functional and structural modifications in the central nervous system after peripheral nerve transfer. Hopefully, it will help surgeons perform successful nerve transfer under the guidance of modern concepts in neuroplasticity.
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Bai Y, Han S, Guan JY, Lin J, Zhao MG, Liang GB. Contralateral C7 nerve transfer in the treatment of upper-extremity paralysis: a review of anatomical basis, surgical approaches, and neurobiological mechanisms. Rev Neurosci 2022; 33:491-514. [PMID: 34979068 DOI: 10.1515/revneuro-2021-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022]
Abstract
The previous three decades have witnessed a prosperity of contralateral C7 nerve (CC7) transfer in the treatment of upper-extremity paralysis induced by both brachial plexus avulsion injury and central hemiplegia. From the initial subcutaneous route to the pre-spinal route and the newly-established post-spinal route, this surgical operation underwent a series of innovations and refinements, with the aim of shortening the regeneration distance and even achieving direct neurorrhaphy. Apart from surgical efforts for better peripheral nerve regeneration, brain involvement in functional improvements after CC7 transfer also stimulated scientific interest. This review summarizes recent advances of CC7 transfer in the treatment of upper-extremity paralysis of both peripheral and central causes, which covers the neuroanatomical basis, the evolution of surgical approach, and central mechanisms. In addition, motor cortex stimulation is discussed as a viable rehabilitation treatment in boosting functional recovery after CC7 transfer. This knowledge will be beneficial towards improving clinical effects of CC7 transfer.
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Affiliation(s)
- Yang Bai
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Song Han
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Jing-Yu Guan
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Jun Lin
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Ming-Guang Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Guo-Biao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
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5
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Cai Z, Lei G, Li J, Shen Y, Gu Y, Feng J, Xu W. Aberrant central plasticity underlying synchronous sensory phenomena in brachial plexus injuries after contralateral cervical seventh nerve transfer. Brain Behav 2021; 11:e02064. [PMID: 33548117 PMCID: PMC8035429 DOI: 10.1002/brb3.2064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/29/2020] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDS Contralateral cervical seventh (C7) nerve transfer aids motor and sensory recovery in total brachial plexus avulsion injuries (TBPI), but synchronous sensation often persists postoperatively. The mechanism underlying synchronous sensory phenomena remain largely unknown. OBJECTIVE To investigate the role of central plasticity in sensory recovery after contralateral C7 nerve transfer. METHODS Sixteen right TBPI patients who received contralateral C7 nerve transfer for more than 2 years were included. Sensory evaluations included Semmes-Weinstein monofilament assessment (SWM), synchronous sensation test, and sensory evoked action potential (SNAP) test. Smaller value in the SWM assessment and larger amplitude of SNAP indicates better tactile sensory. Functional magnetic resonance imaging was performed while stimulations delivered to each hand separately in block-design trials for central plasticity analysis. RESULTS The SWM value of the injured right hand was increased compared with the healthy left side (difference: 1.76, 95% confidence interval: 1.37-2.15, p < .001), and all 16 patients developed synchronous sensation. In functional magnetic resonance imaging analysis, sensory representative areas of the injured right hand were located in its ipsilateral S1, and 23.4% of this area overlapped with the representative area of the left hand. The ratio of overlap for each patient was significantly correlated with SWM value and SNAP amplitude of the right hand. CONCLUSION The tactile sensory functioning of the injured hand was dominated by its ipsilateral SI in long-term observation, and its representative area largely overlapped with the representative area of the intact hand, which possibly reflected a key mechanism of synchronous sensation in patients with TBPI after contralateral C7 transfer.
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Affiliation(s)
- Zeyu Cai
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Gaowei Lei
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yundong Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Juntao Feng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China.,The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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6
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Kim K, Choi HY, Pak K, Jeon H. Changes in brain glucose metabolism following traumatic optic neuropathy in rats. ALL LIFE 2021. [DOI: 10.1080/26895293.2020.1861110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hee-young Choi
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Department of Ophthalmology, Pusan National University Hospital, Busan, South Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hyeshin Jeon
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Department of Ophthalmology, Pusan National University Hospital, Busan, South Korea
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7
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Bahia CP, Vianna-Barbosa RJ, Tovar-Moll F, Lent R. Terminal Arbors of Callosal Axons Undergo Plastic Changes in Early-Amputated Rats. Cereb Cortex 2020; 29:1460-1472. [PMID: 30873555 DOI: 10.1093/cercor/bhy043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 12/26/2022] Open
Abstract
Sensory information is processed in specific brain regions, and shared between the cerebral hemispheres by axons that cross the midline through the corpus callosum. However, sensory deprivation usually causes sensory losses and/or functional changes. This is the case of people who suffered limb amputation and show changes of body map organization within the somatosensory cortex (S1) of the deafferented cerebral hemisphere (contralateral to the amputated limb), as well as in the afferented hemisphere (ipsilateral to the amputated limb). Although several studies have approached these functional changes, the possible finer morphological alterations, such as those occurring in callosal axons, still remain unknown. The present work combined histochemistry, single-axon tracing and 3D microscopy to analyze the fine morphological changes that occur in callosal axons of the forepaw representation in early amputated rats. We showed that the forepaw representation in S1 was reduced in the deafferented hemisphere and expanded in the afferented side. Accordingly, after amputation, callosal axons originating from the deafferented cortex undergo an expansion of their terminal arbors with increased number of terminal boutons within the homotopic representation at the afferented cerebral hemisphere. Similar microscale structural changes may underpin the macroscale morphological and functional phenomena that characterize limb amputation in humans.
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Affiliation(s)
- Carlomagno Pacheco Bahia
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, CEP 21941-902 Rio de Janeiro (RJ), Brazil.,Institute of Health Sciences, Federal University of Pará, CEP 66075-110 Belém (PA), Brazil
| | - Rodrigo Jorge Vianna-Barbosa
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, CEP 21941-902 Rio de Janeiro (RJ), Brazil
| | - Fernanda Tovar-Moll
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, CEP 21941-902 Rio de Janeiro (RJ), Brazil.,D'Or Institute of Research and Education, CEP 22281-100 Rio de Janeiro (RJ), Brazil
| | - Roberto Lent
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, CEP 21941-902 Rio de Janeiro (RJ), Brazil
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8
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Rui J, Zhou YJ, Zhao X, Li JF, Gu YD, Lao J. Endogenous automatic nerve discharge promotes nerve repair: an optimized animal model. Neural Regen Res 2018; 14:306-312. [PMID: 30531014 PMCID: PMC6301173 DOI: 10.4103/1673-5374.244802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Exogenous electrical nerve stimulation has been reported to promote nerve regeneration. Our previous study has suggested that endogenous automatic nerve discharge of the phrenic nerve and intercostal nerve has a positive effect on nerve regeneration at 1 month postoperatively, but a negative effect at 2 months postoperatively, which may be caused by scar compression. In this study, we designed four different rat models to avoid the negative effect from scar compression. The control group received musculocutaneous nerve cut and repair. The other three groups were subjected to side-to-side transfer of either the phrenic (phrenic nerve group), intercostal (intercostal nerve group) or thoracodorsal nerves (thoracic dorsal nerve group), with sural nerve autograft distal to the anastomosis site. Musculocutaneous nerve regeneration was assessed by electrophysiology of the musculocutaneous nerve, muscle tension, muscle wet weight, maximum cross-sectional area of biceps, and myelinated fiber numbers of the proximal and distal ends of the anastomosis site of the musculocutaneous nerve and the middle of the nerve graft. At 1 month postoperatively, compound muscle action potential amplitude of the biceps in the phrenic nerve group and the intercostal nerve group was statistically higher than that in the control group. The myelinated nerve fiber numbers in the distal end of the musculocutaneous nerve and nerve graft anastomosis in the phrenic nerve and the intercostal nerve groups were statistically higher than those in the control and thoracic dorsal nerve groups. The neural degeneration rate in the middle of the nerve graft in the thoracic dorsal nerve group was statistically higher than that in the phrenic nerve and the intercostal nerve groups. At 2 and 3 months postoperatively, no significant difference was detected between the groups in all the assessments. These findings confirm that the phrenic nerve and intercostal nerve have a positive effect on nerve regeneration at the early stage of recovery. This study established an optimized animal model in which suturing the nerve graft to the distal site of the musculocutaneous nerve anastomosis prevented the inhibition of recovery from scar compression.
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Affiliation(s)
- Jing Rui
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
| | - Ying-Jie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji-Feng Li
- Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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9
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Kislay K, Devi BI, Bhat DI, Shukla DP, Gupta AK, Panda R. Novel Findings in Obstetric Brachial Plexus Palsy: A Study of Corpus Callosum Volumetry and Resting-State Functional Magnetic Resonance Imaging of Sensorimotor Network. Neurosurgery 2017; 83:905-914. [DOI: 10.1093/neuros/nyx495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/11/2017] [Indexed: 01/23/2023] Open
Abstract
Abstract
BACKGROUND
The response of the brain to obstetric brachial plexus palsy (OBPP) is not clearly understood. We propose that even a peripheral insult at the developmental stage may result in changes in the volume of white matter of the brain, which we studied using corpus callosum volumetry and resting-state functional magnetic resonance imaging (rsfMRI) of sensorimotor network.
OBJECTIVE
To study the central neural effects in OBPP.
METHODS
We performed an MRI study on a cohort of 14 children who had OBPP and 14 healthy controls. The mean age of the test subjects was 10.07 ± 1.22 yr (95% confidence interval). Corpus callosum volumetry was compared with that of age-matched healthy subjects. Hofer and Frahm segmentation was used. Resting-state fMRI data were analyzed using the FSL software (FMRIB Software Library v5.0, Oxford, United Kingdom), and group analysis of the sensorimotor network was performed.
RESULTS
Statistical analysis of corpus callosum volume revealed significant differences between the OBPP cohort and healthy controls, especially in the motor association areas. Independent t-test revealed statistically significant volume loss in segments I (prefrontal), II (premotor), and IV (primary sensory area). rsfMRI of sensorimotor network showed decreased activation in the test hemisphere (the side contralateral to the injured brachial plexus) and also decreased activation in the ipsilateral hemisphere, when compared with healthy controls.
CONCLUSION
OBPP occurs in an immature brain and causes central cortical changes. There is secondary corpus callosum atrophy which may be due to retrograde transneuronal degeneration. This in turn may result in disruption of interhemispheric coactivation and consequent reduction in activation of sensorimotor network even in the ipsilateral hemisphere.
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Affiliation(s)
- Kishore Kislay
- Departments of Neurosurgery, Nation-al Institute of Mental Health and Neu-rosciences (NIMHANS), Bangalore, India
| | - Bhagavatula Indira Devi
- Departments of Neurosurgery, Nation-al Institute of Mental Health and Neu-rosciences (NIMHANS), Bangalore, India
| | - Dhananjaya Ishwar Bhat
- Departments of Neurosurgery, Nation-al Institute of Mental Health and Neu-rosciences (NIMHANS), Bangalore, India
| | - Dhaval Prem Shukla
- Departments of Neurosurgery, Nation-al Institute of Mental Health and Neu-rosciences (NIMHANS), Bangalore, India
| | - Arun Kumar Gupta
- Departments of Neuroimaging and In-terventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rajanikant Panda
- Departments of Neuroimaging and In-terventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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10
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Feng JT, Liu HQ, Hua XY, Gu YD, Xu JG, Xu WD. Brain functional network abnormality extends beyond the sensorimotor network in brachial plexus injury patients. Brain Imaging Behav 2017; 10:1198-1205. [PMID: 26630882 DOI: 10.1007/s11682-015-9484-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Brachial plexus injury (BPI) is a type of severe peripheral nerve trauma that leads to central remodeling in the brain, as revealed by functional MRI analysis. However, previously reported remodeling is mostly restricted to sensorimotor areas of the brain. Whether this disturbance in the sensorimotor network leads to larger-scale functional remodeling remains unknown. We sought to explore the higher-level brain functional abnormality pattern of BPI patients from a large-scale network function connectivity dimension in 15 right-handed BPI patients. Resting-state functional MRI data were collected and analyzed using independent component analysis methods. Five components of interest were recognized and compared between patients and healthy subjects. Patients showed significantly altered brain local functional activities in the bilateral fronto-parietal network (FPN), sensorimotor network (SMN), and executive-control network (ECN) compared with healthy subjects. Moreover, functional connectivity between SMN and ECN were significantly less in patients compared with healthy subjects, and connectivity strength between ECN and SMN was negatively correlated with patients' residual function of the affected limb. Functional connectivity between SMN and right FPN were also significantly less than in controls, although connectivity between ECN and default mode network (DMN) was greater than in controls. These data suggested that brain functional disturbance in BPI patients extends beyond the sensorimotor network and cascades serial remodeling in the brain, which significantly correlates with residual hand function of the paralyzed limb. Furthermore, functional remodeling in these higher-level functional networks may lead to cognitive alterations in complex tasks.
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Affiliation(s)
- Jun-Tao Feng
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Han-Qiu Liu
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu-Yun Hua
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory, Jing'an District Central Hospital, Shanghai, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian-Guang Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. .,Key Laboratory, Jing'an District Central Hospital, Shanghai, China. .,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
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11
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Qu X, Yan J, Li X, Zhang P, Liu X. Topography of Synchronization of Somatosensory Evoked Potentials Elicited by Stimulation of the Sciatic Nerve in Rat. Front Comput Neurosci 2016; 10:43. [PMID: 27199728 PMCID: PMC4854893 DOI: 10.3389/fncom.2016.00043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/18/2016] [Indexed: 01/14/2023] Open
Abstract
Purpose: Traditionally, the topography of somatosensory evoked potentials (SEPs) is generated based on amplitude and latency. However, this operation focuses on the physical morphology and field potential-power, so it suffers from difficulties in performing identification in an objective manner. In this study, measurement of the synchronization of SEPs is proposed as a method to explore brain functional networks as well as the plasticity after peripheral nerve injury. Method: SEPs elicited by unilateral sciatic nerve stimulation in twelve adult male Sprague-Dawley (SD) rats in the normal group were compared with SEPs evoked after unilateral sciatic nerve hemisection in four peripheral nerve injured SD rats. The characterization of synchronized networks from SEPs was conducted using equal-time correlation, correlation matrix analysis, and comparison to randomized surrogate data. Eigenvalues of the correlation matrix were used to identify the clusters of functionally synchronized neuronal activity, and the participation index (PI) was calculated to indicate the involvement of each channel in the cluster. The PI value at the knee point of the PI histogram was used as a threshold to demarcate the cortical boundary. Results: Ten out of the twelve normal rats showed only one synchronized brain network. The remaining two normal rats showed one strong and one weak network. In the peripheral nerve injured group, only one synchronized brain network was found in each rat. In the normal group, all network shapes appear regular and the network is largely contained in the posterior cortex. In the injured group, the network shapes appear irregular, the network extends anteriorly and posteriorly, and the network area is significantly larger. There are considerable individual variations in the shape and location of the network after peripheral nerve injury. Conclusion: The proposed method can detect functional brain networks. Compared to the results of the traditional SEP-morphology-based analysis method, the synchronized functional network area is much larger. Furthermore, the proposed method can also characterize the rapid cortical plasticity after a peripheral nerve is acutely injured.
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Affiliation(s)
- Xuefeng Qu
- Division of the Comprehensive Epilepsy Center and Neurofunctional Monitoring Laboratory, Department of Neurology, Peking University People's Hospital Beijing, China
| | - Jiaqing Yan
- School of Electrical and Control Engineering, North China University of Technology Beijing, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University Beijing, China
| | - Peixun Zhang
- Department of Trauma and Orthopaedics, Peking University People's Hospital Beijing, China
| | - Xianzeng Liu
- Division of the Comprehensive Epilepsy Center and Neurofunctional Monitoring Laboratory, Department of Neurology, Peking University People's Hospital Beijing, China
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12
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Hua XY, Qiu YQ, Wang M, Zheng MX, Li T, Shen YD, Jiang S, Xu JG, Gu YD, Tsien J, Xu WD. Enhancement of Contralesional Motor Control Promotes Locomotor Recovery after Unilateral Brain Lesion. Sci Rep 2016; 6:18784. [PMID: 26732072 PMCID: PMC4702126 DOI: 10.1038/srep18784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
There have been controversies on the contribution of contralesional hemispheric compensation to functional recovery of the upper extremity after a unilateral brain lesion. Some studies have demonstrated that contralesional hemispheric compensation may be an important recovery mechanism. However, in many cases where the hemispheric lesion is large, this form of compensation is relatively limited, potentially due to insufficient connections from the contralesional hemisphere to the paralyzed side. Here, we used a new procedure to increase the effect of contralesional hemispheric compensation by surgically crossing a peripheral nerve at the neck in rats, which may provide a substantial increase in connections between the contralesional hemisphere and the paralyzed limb. This surgical procedure, named cross-neck C7-C7 nerve transfer, involves cutting the C7 nerve on the healthy side and transferring it to the C7 nerve on the paretic side. Intracortical microstimulation, Micro-PET and histological analysis were employed to explore the cortical changes in contralesional hemisphere and to reveal its correlation with behavioral recovery. These results showed that the contralesional hemispheric compensation was markedly strengthened and significantly related to behavioral improvements. The findings also revealed a feasible and effective way to maximize the potential of one hemisphere in controlling both limbs.
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Affiliation(s)
- Xu-Yun Hua
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan-Qun Qiu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China
| | - Meng Wang
- Hand-Foot Surgery Department, Shandong Provincial Hospital, Shandong, China
| | - Mou-Xiong Zheng
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tie Li
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Dong Shen
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Su Jiang
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian-Guang Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - JoeZ Tsien
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA 30907, USA.,Yunnan BanNa Primate Model Research Center, BanNa Biomedical Research Institute, Xishuangbanna, Yunnan, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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