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Preserved somatosensory conduction in complete spinal cord injury: Discomplete SCI
Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.ORCID-id: 0000-0002-3068-0065
Department of Rehabilitation Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University.
Rehabilitation Medicine Clinic, Sunderby Hospital, Region Norrbotten.
Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
Vise andre og tillknytning
2020 (engelsk)Inngår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 131, nr 5, s. 1059-1067Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: Spinal cord injury (SCI) disrupts the communication between brain and body parts innervated from below-injury spinal segments, but rarely results in complete anatomical transection of the spinal cord. The aim of this study was to investigate residual somatosensory conduction in clinically complete SCI, to corroborate the concept of sensory discomplete SCI.

Methods: We used fMRI with a somatosensory protocol in which blinded and randomized tactile and nociceptive stimulation was applied on both legs (below-injury level) and one arm (above-injury level) in eleven participants with chronic complete SCI. The experimental design accounts for possible confounding mechanical (e.g. vibration) and cortico-cortical top-down mechanisms (e.g. attention/expectation).

Results: Somatosensory stimulation on below-level insensate body regions activated the somatotopically corresponding part of the contralateral primary somatosensory cortex in six out of eleven participants.

Conclusions: Our results represent afferent-driven cortical activation through preserved somatosensory connections to the brain in a subgroup of participants with clinically complete SCI, i.e. sensory discomplete SCI.

Significance: Identifying patients with residual somatosensory connections might open the door for new rehabilitative and restorative strategies as well as inform research on SCI-related conditions such as neuropathic pain and spasticity.

sted, utgiver, år, opplag, sider
Elsevier, 2020. Vol. 131, nr 5, s. 1059-1067
Emneord [en]
Spinal cord injury, Functional MRI, Somatosensory, Discomplete, Non-conscious
HSV kategori
Forskningsprogram
neurologi; neurokirurgi; rehabiliteringsmedicin; fysiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-169138DOI: 10.1016/j.clinph.2020.01.017ISI: 000525862400011PubMedID: 32197128Scopus ID: 2-s2.0-85082123930OAI: oai:DiVA.org:umu-169138DiVA, id: diva2:1416152
Tilgjengelig fra: 2020-03-22 Laget: 2020-03-22 Sist oppdatert: 2022-07-15bibliografisk kontrollert
Inngår i avhandling
1. Functional brain imaging of sensorimotor dysfunction and restoration: investigations of discomplete spinal cord injury and deep brain stimulation for essential tremor
Åpne denne publikasjonen i ny fane eller vindu >>Functional brain imaging of sensorimotor dysfunction and restoration: investigations of discomplete spinal cord injury and deep brain stimulation for essential tremor
2022 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Alternativ tittel[sv]
Funktionell hjärnavbildning av sensorimotorisk dysfunktion och behandling : undersökningar av diskompletta ryggmärgsskador och djup hjärnstimulering vid essentiell tremor
Abstract [en]

The nervous system exists to generate adaptive behaviour by processing sensory input from the body and the environment in order to produce appropriate motor output, and vice versa. Consequently, sensorimotor dysfunction is the basis of disability in most neurological pathologies. In the current thesis, I explore two conditions with different types and degrees of sensorimotor dysfunction by means of functional magnetic resonance imaging (fMRI). In part 1, I assess residual sensory connections to the brain in clinically complete spinal cord injury (SCI) with seemingly complete loss of sensorimotor function below the injury level. In part 2, fMRI is combined with deep brain stimulation (DBS) to investigate interventional mechanisms of restoring dysfunctional sensorimotor control in essential tremor (ET).

Part 1: SCI disrupts the communication between the brain and below-injury body parts, but rarely results in complete anatomical transection of the spinal cord. In studies I and II, we demonstrate somatosensory cortex activation due to somatosensory (tactile and nociceptive) stimulation on below-level insensate body parts in clinically complete SCI. The results from studies I and II indicate preserved somatosensory conduction across the spinal lesion in some cases of clinically complete SCI, as classified according to international standards. This subgroup is referred to as sensory discomplete SCI, which represents a distinct injury phenotype with an intermediate degree of injury severity between clinically complete and incomplete SCI.

Part 2: ET is effectively treated with DBS in the caudal zona incerta, but the neural mechanisms underlying the treatment effect are poorly understood. By exploring DBS mechanisms with fMRI, DBS was shown to cause modulation in the activity of the sensorimotor cerebello-cerebral regions during motor tasks (study III), but did not modulate the functional connectivity during resting-state (study IV).

fMRI is a valuable tool to investigate sensorimotor dysfunction and restoration in SCI and DBS-treated ET. There is evidence for sensory discomplete SCI in about half of the patients with clinically complete SCI. DBS modulates DBS modulation of the activity in the sensorimotor cerebello-cerebral circuit during motor tasks, but not during resting-state, is action-dependent.

sted, utgiver, år, opplag, sider
Umeå: Umeå University, 2022. s. 136
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2194
Emneord
Sensorimotor control, fMRI, discomplete spinal cord injury, essential tremor, deep brain stimulation, cerebello-thalamo-cerebral circuit
HSV kategori
Forskningsprogram
fysiologi; neurokirurgi; neurologi; rehabiliteringsmedicin
Identifikatorer
urn:nbn:se:umu:diva-197840 (URN)978-91-7855-837-7 (ISBN)978-91-7855-838-4 (ISBN)
Disputas
2022-08-29, Hörsal Betula, Målpunkt L, Norrlands universitetssjukhus, Umeå, 09:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2022-08-16 Laget: 2022-07-14 Sist oppdatert: 2022-08-09bibliografisk kontrollert

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