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

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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.

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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

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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.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Lucia Bulubas, Nico Sollmann, Bernhard Meyer & Sandro M. Krieg

  2. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Lucia Bulubas, Nico Sollmann, Claus Zimmer & Sandro M. Krieg

  3. Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Nico Sollmann & Claus Zimmer

  4. Faculty of Linguistics, Philology & Phonetics, University of Oxford, 149 Walton Street, Oxford, OX1 2HG, UK

    Noriko Tanigawa

Authors
  1. Lucia Bulubas
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  2. Nico Sollmann
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  6. Sandro M. Krieg
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Corresponding author

Correspondence to Sandro M. Krieg.

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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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Bulubas, L., Sollmann, N., Tanigawa, N. et al. Reorganization of Motor Representations in Patients with Brain Lesions: A Navigated Transcranial Magnetic Stimulation Study. Brain Topogr 31, 288–299 (2018). https://doi.org/10.1007/s10548-017-0589-4

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  • DOI: https://doi.org/10.1007/s10548-017-0589-4

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