Different cortical areas in man in organization of voluntary movements in extrapersonal space

1. This paper reports regional cerebral blood flow (rCBF) measurements in 254 cortical regions with 133Xe injected into the internal carotid artery in 19 patients, none of whom had any major neurological defect. The purpose was to demonstrate the pattern of cortical activity, as revealed by rCBF increases, during two types of unilateral voluntary movement in extrapersonal space: a) the maze test, series of fast isolated movements in various directions in a frame, executed under verbal command; and b) the drawing of a spiral in the air. 2. Both types of movements were associated with increases of rCBF in the supplementary motor area (bilaterally), the convexity part of the premotor area (bilaterally), the primary sensorimotor hand and arm area (contralaterally), and in the superior and inferior parietal region (bilaterally). 3. During the maze test there were, in addition, bilateral focal increases of the blood flow in the auditory areas, the inferior frontal regions, and the frontal eye fields. 4. It is concluded that the supplementary motor areas, which are also active during programming and execution of movement sequences in intrapersonal space (33), elaborate programs for motor subroutines necessary in skilled voluntary motion. The convexity parts of the premotor areas are activated when a new motor program is established or a previously learned motor program is modulated. The primary motor area is the exclusive executive locus for voluntary movements of the hand and arm. 5. Voluntary movements in extrapersonal space only are associated with activation of the parietal regions. These areas are assumed to provide information to the motor programming neurons about the demanded direction of motion in extrapersonal space in relation to proprioceptive reference systems. 6. The increase of rCBF in the auditory areas, the inferior frontal regions, and the frontal eye fields during the maze test were ascribed to the processing of auditory information. 7. Both tests are accompanied by a diffuse increase of the hemispheric blood flow (approximately 10%), which is assumed to be a parallel to the commonly known desynchronization of the EEG during mental work.