Functional recovery after lesions of the primary motor cortex

After a lesion in the motor cortex of an adult primate, are cortical motor maps reorganized? This important question has attracted much interest throughout the past decade. In human subjects, substantial progress has resulted from the use of noninvasive imaging and stimulation techniques. For example, there is recent, well-accepted, albeit indirect evidence that following such a lesion on one side of the human brain, a dramatic reorganization of the hand representation occurs within either the ipsilateral primary motor cortex, nonprimary motor areas or both. The contribution of contralateral motor areas to functional recovery of the paretic hand remains uncertain, however, because of the lack of direct confirmatory evidence obtained from experiments undertaken on nonhuman primates. A better understanding of how the brain selects the optimal strategy for functional recovery following cortical lesions, and the neuronal mechanisms underlying cortical plasticity, will be important challenges for the next decade. To this end, the purpose of the present chapter is to provide an update on what is truly known about the functional recovery that takes place after a lesion in the primary motor cortex of both the nonhuman primate and the human. It bears emphasis that work on these fundamental issues is an essential prerequisite to the development of improved therapeutic and rehabilitation procedures for the brain-injured human.