Cerebral Cortex Diseases and Cortical Localization

People living with cerebral palsy (CP) exhibit motor and sensory impairments that affect unimanual and bimanual functions. The importance of sensory functions for motor control is well known, but the association between motor and sensory functions remains unclear in people living with CP. The objective of this systematic review was to characterize the relationship between sensory deficits and upper limb motor function in individuals living with CP. Methods: Five databases were screened. The inclusion criteria were: (1) including people living with CP, (2) reporting measurements of upper limb motor and sensory functions. A qualitative analysis of the studies’ level of evidence was done. Results: Thirty-three articles were included. Twenty-five articles evaluated tactile functions, 10 proprioceptive functions and 7 visual functions; 31 of the articles reported on unimanual functions and 17 of them reported on bimanual functions. Tactile functions showed a moderate to high association; it was not possible to reach definitive conclusions for proprioceptive and visual functions. Conclusions: The heterogeneity of the results limits the ability to draw definitive conclusions. Further studies should aim to perform more comprehensive assessments of motor and sensory functions, to determine the relative contribution of various sensory modalities to simple and more complex motor functions.

Brain lesion characteristics (timing, location, and extent) and the type of corticospinal tract (CST) wiring have been proposed as determinants of upper limb (UL) motor function in unilateral cerebral palsy (uCP), yet an investigation of the relative combined impact of these factors on both motor and sensory functions is still lacking. Here, we first investigated whether structural brain lesion characteristics could predict the underlying CST wiring and we explored the role of CST wiring and brain lesion characteristics to predict UL motor and sensory functions in uCP. Fifty-two participants with uCP (mean age (SD): 11 y and 3 m (3 y and 10 m)) underwent a single-pulse Transcranial Magnetic Stimulation session to determine CST wiring between the motor cortex and the more affected hand (n = 17 contralateral, n = 19 ipsilateral, and n = 16 bilateral) and an MRI to determine lesion timing (n = 34 periventricular (PV) lesion, n = 18 corticosubcortical (CSC) lesion), location, and extent. Lesion location and extent were evaluated with a semiquantitative scale. A standardized protocol included UL motor (grip strength, unimanual capacity, and bimanual performance) and sensory measures. A combination of lesion locations (damage to the PLIC and frontal lobe) significantly contributed to differentiate between the CST wiring groups, reclassifying the participants in their original group with 57% of accuracy. Motor and sensory functions were influenced by each of the investigated neurological factors. However, multiple regression analyses showed that motor function was predicted by the CST wiring (more preserved in individuals with contralateral CST (p < 0.01)), lesion extent, and damage to the basal ganglia and thalamus. Sensory function was predicted by the combination of a large and later lesion and an ipsilateral or bilateral CST wiring, which led to increased sensory deficits (p < 0.05). These novel insights contribute to a better understanding of the underlying pathophysiology of UL function and may be useful to delineate individualized treatment strategies.

Objective Upper-limb coordination is crucial for daily activities, especially among stroke survivors who may encounter obstacles during upper-limb rehabilitation. This study aimed to investigate the effects of thermal stimulation (TS) and transcutaneous electrical nerve stimulation (TENS) on sensory and motor function during recovery in acute stroke patients. Design This is a parallel study with a randomized controlled design. The experiment was conducted in the E-Da Hospital Rehabilitation Department, Kaohsiung, Taiwan. Intervention Thirty participants were in-patients with acute stroke at the E-Da Hospital. Participants were randomly assigned tothree groups for a one-week intervention: exercise combined with TS, exercise combined with TENS, or conventional physical therapy with exercise alone. The Fugl-Meyer upper extremity scale, Brunnstrom stage, minimal current perception (MCP), and modified Ashworth scale were collected for the assessment. Results The outcomes demonstrated considerable improvement in MCP in all the groups after treatment. Specifically, the groups receiving TS and TENS showed significant improvements in the Brunnstrom stage, suggesting that both treatments improved distal motor recovery. Conclusion The results, following a one-week intervention period, suggested that both TS and TENS contributed to the improvement of motor and sensory function, with a significant impact on the Brunnstrom stage in the upper extremity, particularly in the distal region. The inclusion of TS or TENS in rehabilitation protocols improved distal motor function compared to baseline measures, suggesting these treatments as effective components in acute stroke rehabilitation.

Congenital cerebello-cerebral cortical degeneration in a calf.

A need exists for mapping the protein profiles in the human brain both during normal and disease conditions. Here we studied 800 antibodies generated toward human proteins as part of a Human Protein Atlas program and investigated their suitability for detailed analysis of various levels of a rat brain using immuno-based methods. In this way, the parallel, rather limited analysis of the human brain, restricted to four brain areas (cerebellum, cerebral cortex, hippocampus, and lateral subventricular zone), could be extended in the rat model to 25 selected areas of the brain. Approximately 100 antibodies (12%) revealed a distinct staining pattern and passed validation of specificity using Western blot analysis. These antibodies were applied to coronal sections of the rat brain at 0.7-mm intervals covering the entire brain. We have now produced detailed protein distribution profiles for these antibodies and acquired over 640 images that form the basis of a publicly available portal of an antibody-based Rodent Brain Protein Atlas database (www.proteinatlas.org/rodentbrain). Because of the systematic selection of target genes, the majority of antibodies included in this database are generated against proteins that have not been studied in the brain before. Furthermore optimized tissue processing and colchicine treatment allow a high quality, more extended annotation and detailed analysis of subcellular distributions and protein dynamics.

Spinal cord injury (SCI) often causes severe functional impairment with poor recovery. The treatment, however, is far from satisfaction, and the mechanisms remain unclear. By using proteomics and western blot, we found spinal cord transection (SCT) resulted in a significant down-regulation of α-synuclein (SNCA) in the motor cortex of SCT rats at 3days post-operation. In order to detect the role of SNCA, we used SNCA-ORF/shRNA lentivirus to upregulate or knockdown SNCA expression. In vivo, SNCA-shRNA lentivirus injection into the cerebral cortex motor area not only inhibited SNCA expression, but also significantly enhanced neurons' survival, and attenuated neuronal apoptosis, as well as promoted motor and sensory function recovery in hind limbs. While, overexpression SNCA exhibited the opposite effects. In vitro, cortical neurons transfected with SNCA-shRNA lentivirus gave rise to an optimal neuronal survival and neurite outgrowth, while it was accompanied by reverse efficiency in SNCA-ORF group. In molecular level, SNCA silence induced the upregulation of Bcl-2 and the downregulation of Bax, and the expression of NGF, BDNF and NT3 was substantially upregulated in cortical neurons. Together, endogenous SNCA play a crucial role in motor and sensory function regulation, in which, the underlying mechanism may be linked to the regulation of apoptosis associated with apoptotic gene (Bax, Bcl2) and neurotrophic factors expression (NGF, BDNF and NT3). These finds provide novel insights to understand the role of SNCA in cerebral cortex after SCT, and it may be as a novel treatment target for SCI repair in future clinic trials.

The purpose of this study was to evaluate the neuroprotective effects of intranasally delivered recombinant human neuronal erythropoietin (Neuro-EPO) on brain injury induced by unilateral permanent ischemia in the Mongolian gerbil. Expression of EPO receptor (EPOR) and neuroglobin (Ngb) over 5 weeks after intranasal treatment with Neuro-EPO was determined using immunohistochemistry. Mortality of Neuro-EPO-treated gerbils decreased after surgery, and the sensory and motor function was significantly improved. Histopathological mapping showed that Neuro-EPO significantly reduced delayed neuronal death in the brain. Expression of Ngb was upregulated in the cerebral cortex at most time points (expect for 10 min and 48 hr) and in the hippocampus at 10 min and from 48 hr to 5 weeks, whereas EPOR was almost downregulated or unchanged in the brain (expect for 48 hr). The 10 min and 48 hr seemed to be two time points for the brain to switch the expression of both Ngb and EPOR to early and late recovery phase, respectively. In addition, there were two phases, 10 min to 1 hr and 24 hr to 72 hr, respectively, closing to the "golden hour" of about 60 min and the "silver day" of 1 to 3 days, for the brain to recover from stroke onset with intranasal Neuro-EPO treatment. Therefore, the results suggest that the intranasal administration of Neuro-EPO is effective in the treatment of acute brain ischemia. The different expression patterns of Ngb and EPOR is probably due to ischemic tolerance in the cerebral cortex and ischemic sensitivity in the hippocampus.

Classic paired associative stimulation can improve synaptic plasticity, as demonstrated by animal experiments and human clinical trials in spinal cord injury patients. Paired associative magnetic stimulation (dual-target peripheral and central magnetic stimulation) has been shown to promote neurologic recovery after stroke. However, it remains unclear whether paired associative magnetic stimulation can promote recovery of lower limb motor dysfunction after spinal cord injury. We hypothesize that the current caused by central and peripheral magnetic stimulation will converge at the synapse, which will promote synapse function and improve the motor function of the relevant muscles. Therefore, this study aimed to examine the effects of paired associative magnetic stimulation on neural circuit activation by measuring changes in motor evoked and somatosensory evoked potentials, motor and sensory function of the lower limbs, functional health and activities of daily living, and depression in patients with spinal cord injury. We will recruit 110 thoracic spinal trauma patients treated in the Department of Spinal Cord Injury, China Rehabilitation Hospital and randomly assign them to experimental and control groups in a 1:1 ratio. The trial group (n = 55) will be treated with paired associative magnetic stimulation and conventional rehabilitation treatment. The control group (n = 55) will be treated with sham stimulation and conventional rehabilitation treatment. Outcomes will be measured at four time points: baseline and 4, 12, and 24 weeks after the start of intervention (active or sham paired associative magnetic stimulation). The primary outcome measure of this trial is change in lower limb American Spinal Injury Association Impairment Scale motor function score from baseline to last follow-up. Secondary outcome measures include changes in lower limb American Spinal Injury Association sensory function score, motor evoked potentials, sensory evoked potentials, modified Ashworth scale score, Maslach Burnout Inventory score, and Hamilton Depression Scale score over time. Motor evoked potential latency reflects corticospinal tract transmission time, while amplitude reflects recruitment ability; both measures can help elucidate the mechanism underlying the effect of paired associative magnetic stimulation on synaptic efficiency. Adverse events will be recorded. Findings from this trial will help to indicate whether paired associative magnetic stimulation (1) promotes recovery of lower limb sensory and motor function, reduces spasticity, and improves quality of life; (2) promotes neurologic recovery by increasing excitability of spinal cord motor neurons and stimulating synaptic plasticity; and (3) improves rehabilitation outcome in patients with spinal cord injury. Recruitment for this trial began in April 2021 and is currently ongoing. It was approved by the Ethics Committee of Yangzhi Affiliated Rehabilitation Hospital of Tongji University, China (approval No. YZ2020-018) on May 18, 2020. The study protocol was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2100044794) on March 27, 2021 (protocol version 1.0). This trial will be completed in April 2022.

Connectivity of the human insula: A cortico-cortical evoked potential (CCEP) study

Cortical vision impairment (CVI) and Cerebral Palsy (CP) lead to decrement in sensory and motor functions of infants. The current study examined the effectiveness of sensory integration interventions on sensory, motor, and oculomotor skills in infants with cortical vision impairment. Thirty-four infants with and CP aged 12–18 months were enrolled to the study. The infants were randomly divided into two groups as the control and intervention groups. The intervention group took sensory integration intervention 2 days a week for 8 weeks in addition to conventional physiotherapy 2 days a week for 8 weeks. The control group only received the conventional physiotherapy program 2 days a week for 8 weeks. The duration of the treatment sessions were 45 min for both interventions. Before and after the intervention, sensory processing functions were evaluated with the Test of Sensory Functions in Infants (TSFI), and motor functions were evaluated with the Alberta Infant Motor Scale (AIMS). There was a statistically significant difference between the pre- and post-test mean TSFI total and AIMS scores in the intervention group and control group (p < 0.001). The intervention group mean TSFI scores were more statistically significant than the those of the control group. Mean post-intervention AIMS scores did not differ between groups. Sensory integration intervention delivered with the conventional physiotherapy program was more effective than the conventional physiotherapy program in increasing sensory processing skills in one measure in infants with CVI and CP.

BackgroundFrailty has been associated with a decline in sensory and motor function. However, given that different frailty measures were shown to overlap but also differ in their diagnostic properties, sensory and motor correlates of frailty might be different depending on the operationalization of frailty. Our objective was to identify sensory and motor determinants of frailty and compare the results between frailty phenotype (FP) and frailty index (FI).MethodsData from 44 pre-frail and frail subjects aged 65 and above were used. Frailty was measured using the FP and the FI. Sensory function in the visual, auditory, and tactile domain was assessed using visual acuity, absolute hearing threshold and mechanical detection threshold. Upper extremity motor performance was evaluated by the Purdue Pegboard Test and the Short Physical Performance Battery was used to assess lower extremity motor function. Multiple logistic regression models were employed to determine associations of sensory and motor function with frailty vs. pre-frailty for both frailty measures.ResultsThe frailty measures were moderately correlated (0.497, p ≤ 0.01) and had a Kappa agreement of 0.467 (p = 0.002). Using the FP, frailty was significantly associated with reduced upper extremity motor function only (OR = 0.50, 95% CI 0.29–0.87, p = 0.014). Frailty as assessed by the FI was significantly related to higher hearing thresholds (OR = 1.21, 95% CI 1.02–1.43, p = 0.027) and reduced lower extremity performance (OR = 0.32, 95% CI 0.13–0.77, p = 0.012).ConclusionFrailty is related to reduced performance in measures of sensory and motor function. However, traditional measures of frailty might be differentially sensitive to capture sensory and motor decline, possibly contributing to the much-observed discordance between the diagnostic instruments. This should be taken into account by researchers and clinicians when planning and evaluating therapeutic interventions for frailty.Trial registrationClinicalTrials.gov NCT03666039. Registered 11 September 2018 – Retrospectively registered.

The cerebral cortex is the outermost layer of the cerebrum and plays a critical role in various cognitive, sensory and motor functions. It is highly folded and has distinct regions responsible for different functions. Leachate refers to the liquid that forms when water percolates through waste materials, such as landfills and dumpsite picking up various organic and inorganic compounds along the way. It is a complex mixture of chemicals, including heavy metals, volatile organic compounds (VOC) and other potentially harmful substances. Eliozu dumpsite is one of the biggest dumpsite in Port Harcourt metropolis. It receives deposits of both domestic and industrial wastes from Port Harcourt, these wastes are dumped untreated, and thus may pose serious environmental risks to inhabitants in the area. The present study focuses on the assessment of the cytomorphology of the cerebral cortex exposed to Eliozu dumpsite leachate using Wistar rats as model. Twenty five (25) male Wistar rats were divided into five groups of five animals each; the leachate was collected from the dumpsite and water from near-by borehole also collected. Group 1 which served as control group received 1ml of commercial bottle water, group 2 received 1ml of borehole water 1kilometer from the dumpsite, groups 3, 4 and 5 received different concentration of the leachate in 10%, 50% and 100% for ninety days, the animals were sacrificed after being anesthetized with chloroform vapor, the brains were collected and put in 10% formaldehyde, sectioned and stained with haematoxylin and eosin (H&amp;E), special stain Gorgon and Sweet for histopathological studies. The slides were placed in a light microscope and analyzed by a consultant Anatomy pathologist. The results revealed that the Eliozu dumpsite leachate does have deleterious effect on the cytomorphology of the cerebral cortex. Eliozu dumpsite leachate has shown deleterious effect on cerebral cortex which is an indication of toxicity that may cause brain death to the experimental animals. Therefore, it is recommended that continued research, education and public awareness are essential to promote sustainable waste management practices and safeguard the integrity of the cerebral cortex.

ID 375 – Abnormal recovery functions of somatosensory evoked potentials in HTLV-1-associated myelopathy

The brain and spinal cord work together to provide sensory perception and motor function to the body. These processes are accomplished by connections that occur between the brain and peripheral nervous system through the spinal cord. Injury to the spinal cord can lead to significant deficits. Traumatic events can lead to compression, ischemia or destruction of the spinal cord with consequential weakness, paralysis, sensory disturbances or urinary incontinence. Traumatic spinal cord injuries are classified as either complete (complete loss of motor and sensory function) or incomplete injuries (preservation of some motor or sensory function distal to the site of injury). The spinal cord can also be the site of aberrant neoplastic growth (spinal cord tumours) or immune‐modulated pathologies that lead to destruction and damage to the spinal cord (multiple sclerosis). Tumours, vascular diseases, infections, inflammatory diseases, demyelinating diseases and nutritional diseases can all result in damage to the spinal cord. Key concepts The vertebrae are specifically arranged to allow for protection of the spinal cord as well supporting and permitting movement of the trunk and limbs. The spinal cord is divided into distinct regions that receive their blood supply from different branches off of the aorta and provide innervation to different regions of the body. There are ascending sensory tracts and descending motor tracts connecting the spinal cord to the brain. These tracts are located regionally in the spinal cord according to function and injury to a particular region leads to symptoms that correlate with the respective function of the damaged area. Spinal cord tumours can be primary (arise from the spinal cord or its surrounding meninges) or secondary to metastastic spread. Tumours are classified according to their location relative to the dura mater which surrounds the spinal cord. Vascular malformations result in abnormal flow of blood within the spinal cord. They often shunt blood directly between arteries and veins, bypassing the capillary network. These malformations have a propensity to bleed. If an artery providing blood to the spinal cord is blocked or occluded, spinal cord infarct or stroke ensues. Pathogens in the blood can enter the central nervous system (CNS; brain and spinal cord) and lead to infection, inflammatory response and damage to the spinal cord. Inflammatory diseases often arise idiopathically (cause unknown); some association exists between viral infections and autoimmune diseases. Demyelination of nerves and destruction of spinal cord tracts typically result and is seen in conditions such as sarcoidosis, transverse myelitis, and Guillain–Barre. Autoimmune diseases result when a maladaptive immune system recognizes the host tissue as foreign and mounts an inappropriate immune response. multiple sclerosis and acute disseminated encephalomyelitis are two disorders where one's immune system mounts an attack against normal white matter of the CNS. Vitamin B12 is obtained through the diet and is important for the formation and maintenance of the myelin sheath that surrounds neurons. Traumatic injury to the spinal cord most commonly occurs due to motor vehicle accidents and can lead to paraplegia (lower extremity paralysis) or quadriplegia (upper and lower extremity paralysis). An incomplete spinal cord injury is one where some motor or sensory function is preserved distal to the level of injury. Treatment consists of realignment and stabilization of the vertebral column, decompression of mass lesions and prevention of hypoxia and hypotension (preventing the spinal cord from being deprived of oxygen and blood nutrients).

The sensory and motor functions in severe tuberculous meningitis (TBM) may be difficult to assess clinically and may be helped by evoked potential studies. Lack of motor and somatosensory evoked potential studies in TBM prompted the present study. All the patients with TBM underwent detailed neurological evaluation and cranial CT scan study. Motor and somatosensory evoked potentials to both upper and lower limbs were carried out bilaterally. The outcome was defined on the basis of 3 month Barthel Index (BI) score into good (BI > 12) and poor (BI < 12). Forty-one highly probable patients with TBM whose ages ranged between 8 and 64 years and 14 of whom were females were included in this study. Twenty-three patients were in stage III (meningitis, neurological signs and altered sensorium), 12 in stage II (meningitis with neurological sign) and the remaining patients were in stage I (meningitis only). Cranial CT scan was carried out in all and MRI in 18 patients. On CT scan hydrocephalus was present in 21, infarction in 14 and tuberculoma in 4 patients. Motor evoked potential (MEP) was abnormal in 18 patients (36 limbs) and SEP in 9 patients (23 limbs). Upper limb central motor conduction time to abductor digiti minimi (CMCT-ADM) was abnormal in 15 and that to tibialis anterior (TA) in 21 limbs. CMCT abnormality was lateralized in 6 and only upper or lower limbs were involved in 11 patients. The SEP abnormalities were lateralized in 2 patients and only upper or lower limbs were involved in 3. The MEP changes correlated with stage of TBM and outcome whereas SEP with outcome only. Motor and somatosensory evoked potentials may be helpful in objective documentation of respective motor and sensory functions in TBM patients with altered sensorium.