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Apraxia and motor dysfunction in corticobasal syndrome
James R Burrell1, Michael Hornberger2, Steve Vucic3
1Neuroscience Research Australia, Sydney, New South Wales, Australia; Prince of Wales Clinical School Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
Plos One
|March 26, 2014
Summary
Corticobasal syndrome (CBS) involves motor and cognitive issues, including limb apraxia. This study links TMS-assessed motor cortex dysfunction and atrophy to CBS symptoms, suggesting cortical dysfunction underlies the condition.
Area of Science:
- Neuroscience
- Neurology
- Cognitive Science
Background:
- Corticobasal syndrome (CBS) presents with complex motor and cognitive impairments, notably limb apraxia and visuospatial deficits.
- Transcranial magnetic stimulation (TMS) has been used to investigate motor system dysfunction in CBS, but its relation to clinical features remains unclear.
- This study hypothesizes that limb apraxia in CBS may stem from visuospatial impairment and that motor dysfunction, detectable by TMS, correlates with apraxia.
Purpose of the Study:
- To investigate the link between limb apraxia and visuospatial deficits in Corticobasal syndrome (CBS).
- To demonstrate motor system dysfunction in CBS using threshold-tracking TMS and its association with limb apraxia.
- To explore the relationship between primary motor cortex atrophy (via VBM) and motor dysfunction/limb apraxia in CBS.
Main Methods:
- Limb apraxia assessed by imitating meaningful/meaningless hand gestures.
- Cognitive function evaluated using Addenbrooke's Cognitive Examination - Revised (ACE-R), focusing on visuospatial tasks.
- Cortical function assessed via Transcranial Magnetic Stimulation (TMS) and brain atrophy via Voxel-Based Morphometry (VBM).
Main Results:
- Of 17 CBS patients, 76.5% showed cortical dysfunction via TMS; 23.5% had an inexcitable motor cortex.
- Reduced resting motor threshold and poorer visuospatial performance correlated significantly with limb apraxia.
- Cortical dysfunction linked to atrophy in primary/pre-motor cortices and thalamus; apraxia correlated with pre-motor/parietal atrophy.
Conclusions:
- Cortical dysfunction is a key factor in the core clinical features of Corticobasal syndrome (CBS).
- Atrophy in primary motor, pre-motor cortices, and thalamus is associated with this cortical dysfunction.
- Limb apraxia in CBS is specifically correlated with atrophy in the pre-motor and parietal cortical regions.
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