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Motor cortex localization using functional MRI and transcranial magnetic stimulation.

R A Macdonell¹, G D Jackson, J M Curatolo

¹Department of Neurology, Austin & Repatriation Medical Centre, Victoria, Australia.

|October 26, 1999

Summary

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Functional MRI (fMRI) and transcranial magnetic stimulation (TMS) successfully mapped motor cortex function in a patient with congenital brain lesions. Both techniques confirmed motor function migration, aiding epilepsy surgery planning.

Area of Science:

Neuroscience
Neurosurgery
Medical Imaging

Background:

Congenital brain lesions can cause focal seizures and neuronal plasticity, altering motor and sensory functions.
Noninvasive techniques like functional MRI (fMRI) and transcranial magnetic stimulation (TMS) can localize the motor cortex.
Correlation studies between fMRI and TMS for motor cortex localization are limited.

Observation:

A young woman with intractable focal seizures, congenital left arm weakness, and a dysplastic right hemisphere was studied.
fMRI and TMS were employed to map the motor cortex in this patient.
The study aimed to assess the agreement between fMRI and TMS in localizing motor representation.

Findings:

Excellent agreement was observed in localizing hand motor representation, predominantly in the left hemisphere.

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fMRI detected posterior activation in the right hemisphere, but TMS, direct cortical stimulation, and Wada testing found no descending corticospinal projections.

Both fMRI and TMS demonstrated the migration of left-hand motor function to the left motor cortex.

Implications:

fMRI and TMS are valuable tools for localizing cortical motor function prior to epilepsy surgery.
The complementary nature of fMRI and TMS provides comprehensive information for surgical planning.
Resection of the dysplastic right precentral gyrus did not result in permanent motor deficits, suggesting successful functional reorganization and surgical intervention.