Primary motor hand area corticospinal excitability indicates overall functional recovery after spinal cord injury

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1175078 · Published: June 2, 2023

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

This study investigates how the excitability of the primary motor cortex (M1) hand area changes after spinal cord injury (SCI) and how these changes relate to motor function. The study found that the excitability of the dominant hemisphere M1 hand area decreases in SCI patients. The closer the degree of M1 hand area MEP hemispheric conversion is to that of healthy controls, the better the extremity motor function/ADL ability patients achieve.

Study Duration

January 2017 to August 2022

Participants

347 SCI patients and 80 healthy controls

Evidence Level

Not specified

Key Findings

1
The CSE of the dominant hemisphere M1 hand area decreased in SCI patients.
2
The degree of M1 hand area MEP hemispheric conversion was positively correlated with total motor score, lower extremity motor score (LEMS), and ADL ability in specific SCI patient subgroups.
3
The degree of hemispheric CSE conversion is an independent factor for assessing changes in ADL ability.

Research Summary

This study examined the changes in corticospinal excitability (CSE) of the primary motor cortex (M1) hand area after spinal cord injury (SCI) and its correlation with motor function and activities of daily living (ADL). The results indicated that the CSE of the dominant hemisphere M1 hand area decreased in SCI patients, and the degree of M1 hand area MEP hemispheric conversion was correlated with motor function and ADL ability. The study suggests that regulating the excitability of bilateral M1 hand areas might be a novel strategy for SCI overall functional recovery.

Practical Implications

Targeted Intervention Strategy

Targeted regulation to the M1 hand area excitability might improve the motor function and ADL ability in SCI patients.

Therapeutic Guidance

Enhance the NDH M1 hand area excitability but attenuate the DH M1 hand area excitability, so as to regulate the degree of hemispheric CSE conversion in the SCI patient closer to that of normal status.

Functional Prognosis

CSE conversion may serve as a potential indicator for the evaluation of functional prognosis with the ultimate goal to improve the quality of life in SCI patients.

Study Limitations

1
Limited number of patients with complete, analyzable, bilateral M1 hand area MEP data.
2
The research is a retrospective study, a cohort study is urgently needed.
3
Targeted intervention like rTMS on the M1 hand area should also be conducted subsequently through a randomized controlled trial.

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