Neuroimaging patterns associated with motor control in traumatic brain injury.

OBJECTIVE: To determine if patients with traumatic brain injury (TBI) and motor deficits show differences in functional activation maps during repetitive hand movements relative to healthy controls. Are there predictors for motor outcome in the functional maps of these patients? METHODS: In an exploratory cross-sectional study, functional magnetic resonance imaging (fMRI) was used to study the blood-oxygenation-level-dependent (BOLD) response in cortical motor areas of 34 patients suffering from moderate motor deficits after TBI as they performed unilateral fist-clenching motions. Twelve of these patients with unilateral motor deficits were studied 3 months after TBI and a 2nd time approximately 4 months later. RESULTS: Compared to age-matched, healthy controls performing the same task, TBI patients showed diminished fMRI-signal change in the primary sensorimotor cortex contralateral to the moving hand (cSM1), the contralateral dorsal premotor cortex, and bilaterally in the supplementary motor areas (SMAs). Clinical impairment and the magnitude of the fMRI-signal change in cSM1 and SMA were negatively correlated. Patients with poor and good motor recovery showed comparable motor impairment at baseline. Only patients who evolved to "poor clinical outcome" had decreased fMRI-signal change in the cSM1 during baseline. CONCLUSIONS: These observations raise the hypothesis that the magnitude of the fMRI-signal change in the cSM1 region could have prognostic value in the evaluation of patients with TBI.

Functional lateralization of speech production at primary motor cortex: a fMRI study.

To evaluate lateralization of speech production at the level of the Rolandic cortex, functional magnetic resonance imaging (1.5 Tesla, 27 parallel axial slices, EPI-technique) was performed during a speech task (continuous silent recitation of the names of the months of the year). As control conditions, non-speech tongue movements and silent singing of a well-known melody with the syllable 'la' as its carrier were considered. Tongue movements produced symmetrical activation at the lower primary motor cortex. During automatic speech a strong functional lateralization to the left hemisphere emerged within the same area. In contrast, singing yielded a predominant right-sided activation of the Rolandic region. Functional lateralization of speech production therefore seems to include the precentral gyrus as well as Broca's area.

Dynamical cluster analysis of cortical fMRI activation.

Localized changes in cortical blood oxygenation during voluntary movements were examined with functional magnetic resonance imaging (fMRI) and evaluated with a new dynamical cluster analysis (DCA) method. fMRI was performed during finger movements with eight subjects on a 1.5-T scanner using single-slice echo planar imaging with a 107-ms repetition time. Clustering based on similarity of the detailed signal time courses requires besides the used distance measure no assumptions about spatial location and extension of activation sites or the shape of the expected activation time course. We discuss the basic requirements on a clustering algorithm for fMRI data. It is shown that with respect to easy adjustment of the quantization error and reproducibility of the results DCA outperforms the standard k-means algorithm. In contrast to currently used clustering methods for fMRI, like k-means or fuzzy k-means, DCA extracts the appropriate number and initial shapes of representative signal time courses from data properties during run time. With DCA we simultaneously calculate a two-dimensional projection of cluster centers (MDS) and data points for online visualization of the results. We describe the new DCA method and show for the well-studied motor task that it detects cortical activation loci and provides additional information by discriminating different shapes and phases of hemodynamic responses. Robustness of activity detection is demonstrated with respect to repeated DCA runs and effects of different data preprocessing are shown. As an example of how DCA enables further analysis we examined activation onset times. In areas SMA, M1, and S1 simultaneous and sequential activation (in the given order) was found.

Proton MR spectroscopy in succinic semialdehyde dehydrogenase deficiency.

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare hereditary disorder of the CNS catabolism of gamma-aminobutyric acid (GABA), leading to accumulation of the metabolite 4-hydroxybutyrate (GHB). Here the authors report on 1.5 and 3.0 T proton MR spectroscopy in a patient with SSADH deficiency. A characteristic pattern with clearly elevated GABA levels and traces of GHB was found in both the white and the gray matter of the brain. In vivo spectroscopy may be useful for diagnosis and monitoring SSADH deficiency.