人类皮质运动系统中的功能连接:一项皮质-皮质诱发电位研究。

Functional connectivity in human cortical motor system: a cortico-cortical evoked potential study.

作者信息

Matsumoto Riki, Nair Dileep R, LaPresto Eric, Bingaman William, Shibasaki Hiroshi, Lüders Hans O

机构信息

Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

出版信息

Brain. 2007 Jan;130(Pt 1):181-97. doi: 10.1093/brain/awl257. Epub 2006 Oct 17.

Abstract

In order to understand the complex functional organization of the motor system, it is essential to know the anatomical and functional connectivity among individual motor areas. Clinically, knowledge of these cortico-cortical connections is important to understand the rapid spread of epileptic discharges through the network underlying ictal motor manifestation. In humans, however, knowledge of neuronal in vivo connectivity has been limited. We recently reported a new method, 'cortico-cortical evoked potential (CCEP)', to electrically track the cortico-cortical connections by stimulating a part of the brain through subdural electrodes and recording the cortical evoked potentials that emanate from a distant region of the cortex via neuronal projections. We applied the CCEP methodology to investigate in vivo cortico-cortical connections between the lateral motor cortex [LMCx; sensorimotor (SM) and lateral premotor areas] and the medial motor cortex [MMCx; supplementary motor area proper (SMA), pre-SMA and foot SM]. Seven patients with intractable partial epilepsy were studied. These patients had chronic implantation of subdural electrodes covering part of the lateral and medial frontal areas. As a part of the routine pre-surgical evaluation, comprehensive cortical mapping was performed by electrical stimulation of the subdural electrodes, and the precise localization of the subdural electrodes was defined by MRI co-registration. Single-pulse electrical stimuli were delivered to MMCx (7 patients) and LMCx (4), and CCEPs time-locked to the stimuli were recorded by averaging electrocorticograms from LMCx and MMCx, respectively. Short-latency CCEPs were observed when stimulating MMCx and recording from LMCx (mean latency: 21.6 ms, range: 9-47 ms) and vice versa when stimulating LMCx and recording from MMCx (mean latency: 29.4 ms, range: 11-57 ms). In terms of the location of these stimulus sites and CCEP responses along the rostrocaudal axis, regression analysis revealed a consistent correlation between the sites of stimulation and maximum CCEP for stimulation of both MMCx and LMCx. Functionally, stimulation of the positive motor areas in MMCx elicited CCEPs at the somatotopically homologous regions in LMCx (71%). The same findings were observed in MMCx (82%) upon stimulation of LMCx. In four subjects in whom bi-directional connectivity was investigated by stimulating both MMCx and LMCx, reciprocality was observed in the majority of connections (78-94%). In conclusion, the present study demonstrated a human motor cortico-cortical network connecting (i) anatomically homologous areas of LMCx and MMCx along the rostrocaudal cognitive-motor gradient; and (ii) somatotopically homologous regions in LMCx and MMCx in a reciprocal manner.

摘要

为了理解运动系统复杂的功能组织,了解各个运动区域之间的解剖学和功能连接至关重要。临床上,了解这些皮质 - 皮质连接对于理解癫痫放电通过发作性运动表现背后的网络快速传播很重要。然而,在人类中,关于神经元体内连接的知识一直有限。我们最近报道了一种新方法,即“皮质 - 皮质诱发电位(CCEP)”,通过硬膜下电极刺激大脑的一部分并记录经由神经元投射从皮质远处区域发出的皮质诱发电位,来电追踪皮质 - 皮质连接。我们应用CCEP方法来研究外侧运动皮质[LMCx;感觉运动(SM)和外侧运动前区]与内侧运动皮质[MMCx;真正的辅助运动区(SMA)、前SMA和足部SM]之间的体内皮质 - 皮质连接。研究了7例难治性部分性癫痫患者。这些患者长期植入覆盖部分外侧和内侧额叶区域的硬膜下电极。作为常规术前评估的一部分,通过硬膜下电极的电刺激进行全面的皮质图谱绘制,并通过MRI配准确定硬膜下电极的精确定位。将单脉冲电刺激施加到MMCx(7例患者)和LMCx(4例),并分别通过平均来自LMCx和MMCx的皮质电图记录与刺激锁时的CCEP。刺激MMCx并从LMCx记录时观察到短潜伏期CCEP(平均潜伏期:21.6毫秒,范围:9 - 47毫秒),反之,刺激LMCx并从MMCx记录时也观察到(平均潜伏期:29.4毫秒,范围:11 - 57毫秒)。就这些刺激部位的位置以及沿前后轴的CCEP反应而言,回归分析揭示了刺激MMCx和LMCx时刺激部位与最大CCEP之间存在一致的相关性。在功能上,刺激MMCx中的积极运动区域在LMCx中躯体定位同源区域引发CCEP(71%)。刺激LMCx时在MMCx中也观察到相同的结果(82%)。在通过刺激MMCx和LMCx研究双向连接的4名受试者中,在大多数连接中观察到相互性(78 - 94%)。总之,本研究证明了一个人类运动皮质 - 皮质网络,该网络(i)沿着前后认知运动梯度连接LMCx和MMCx的解剖学同源区域;以及(ii)以相互的方式连接LMCx和MMCx中的躯体定位同源区域。

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