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Journal of Neuroscience, Vol 11, 3656-3666, Copyright © 1991 by Society for Neuroscience
Functional organization of human supplementary motor cortex studied by electrical stimulation
I Fried, A Katz, G McCarthy, KJ Sass, P Williamson, SS Spencer and DD Spencer
Section of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510.
The presence of somatotopic organization in the human supplementary motor
area (SMA) remains a controversial issue. In this study, subdural electrode
grids were placed on the medial surface of the cerebral hemispheres in 13
patients with intractable epilepsy undergoing evaluation for surgical
treatment. Electrical stimulation mapping with currents below the threshold
of afterdischarges showed somatotopic organization of supplementary motor
cortex with the lower extremities represented posteriorly, head and face
most anteriorly, and the upper extremities between these two regions.
Electrical stimulation often elicited synergistic and complex movements
involving more than one joint. In transitional areas between neighboring
somatotopic representations, stimulation evoked combined movements
involving the body parts represented in these adjacent regions. Anterior to
the supplementary motor representation of the face, vocalization and speech
arrest or slowing of speech were evoked. Various sensations were elicited
by electrical stimulation of SMA. In some cases a preliminary sensation of
"urge" to perform a movement or anticipation that a movement was about to
occur were evoked. Most responses were contralateral to the stimulated
hemisphere. Ipsilateral and bilateral responses were elicited almost
exclusively from the right (nondominant) hemisphere. These data suggest the
presence of combined somatotopic organization and left-right specialization
in human supplementary motor cortex.
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