Differential effect of spinal cord injury and functional impairment on human brain activation

• Published in: Journal of neurotrauma Vol. 19; no. 1; pp. 43 - 51
• Main Authors: CURT, A, BRUEHLMEIER, M, LEENDERS, K. L, ROELCKE, U, DIETZ, V
• Format: Journal Article
• Language: English
• Published: Larchmont, NY Liebert 2002; Mary Ann Liebert, Inc
• Subjects: Adult; Biological and medical sciences; Brain; Brain Mapping; Female; Hand; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Motor Cortex - diagnostic imaging; Motor Cortex - physiopathology; Neuronal Plasticity - physiology; Paralysis; Paraplegia - diagnostic imaging; Paraplegia - physiopathology; Psychomotor Performance; Quadriplegia - diagnostic imaging; Quadriplegia - physiopathology; Somatosensory Cortex - diagnostic imaging; Somatosensory Cortex - physiopathology; Spinal cord injuries; Spinal Cord Injuries - diagnostic imaging; Spinal Cord Injuries - physiopathology; Tomography; Tomography, Emission-Computed; Trauma; Traumas. Diseases due to physical agents; Switzerland; Radionuclide study; Human; Nervous system diseases; Central nervous system disease; Central nervous system; Sensorimotor cortex; Evolution; Activation; Spinal cord disease; Brain (vertebrata); Positron; Emission tomography
• ISSN: 0897-7151; 1557-9042
• DOI: 10.1089/089771502753460222

Reorganization of human brain function after spinal cord injury (SCI) has been shown in electrophysiological studies. However, it is less clear how far changes of brain activation in SCI patients are influenced by the extent of SCI (neuronal lesion) or the consequent functional impairment. Positron emission tomography ([15O]-H2O-PET) was performed during an unilateral hand movement in SCI patients and healthy subjects. SCI patients with paraplegia and normal hand function were compared to tetraplegic patients with impaired hand movements. Intergroup comparison between paraplegic patients and healthy subjects showed an increased activation of contralateral sensorimotor cortex (SMC), contralateral thalamus, ipsilateral superior parietal lobe, and bilateral cerebellum. In contrast to this, tetraplegic patients with impaired upper limb function revealed only a significant activation of supplementary motor area (SMA). Correlational analysis in the tetraplegic patients showed that the strength of hand movement was related to the activation of contralateral SMC. However, the severity of upper limb sensorimotor deficit was related to a reduced activation of contralateral SMA and ipsilateral cerebellum. The findings suggest that in paraplegic patients with normal hand function the spinal neuronal lesion itself induces a reorganization of brain activation unrelated to upper limb function. Compared to this, in tetraplegic patients changes of brain activation are related to the impaired upper limb function. Therefore, in patients with SCI a differential impact of spinal lesion and functional impairment on brain activation can be shown. The effect of impaired afferent feedback and/or increased compensatory use of non-impaired limbs in SCI patients needs further evaluation.