[Motor reorganization in the motor cortex]

Plasticity within the human central motor system has been studied with transcranical magnetic stimulation in patients with peripheral and central nervous diseases. In 4 patients with a complete upper limb palsy due to traumatic cervical root avulsion, surgical anastomosis of intercostal to musculocutaneous nerves was performed to restore function in the biceps brachii muscle. The motor unit discharges became independent from respirations gradually over 1 to 2 years. Motor cortex mapping of the reinnervated biceps muscle showed a gradual change over 4 to 33 months from the area of the intercostal muscles to that of the arm area, which was more lateral on the motor cortex. These findings suggest that reorganization of the motor cortex to arm flexor muscles occurs following peripheral nerve anastomosis. In 8 patients with chronic cerebral infarction with hemiplegia. Four of 8 patients did not show MEPs in paralytic hand muscles by contralateral cortex stimulation, but showed small MEPs by ipsilateral cortex stimulation. These cases had the huge cortical infarction unilaterally in CT. Another four of 8 patients showed small MEPs in paralytic hand muscles by contralateral cortex stimulation, but no MEPs by ipsilateral cortex stimulation. These cases had the subcortical infarction unilaterally in CT. These findings suggest that reorganization of motor cortex following unilateral cerebral infarction.