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The Journal of Neuroscience, May 1, 1998, 18(9):3443-3450
Mechanisms of Cortical Reorganization in Lower-Limb Amputees
Robert Chen, Brian Corwell, Zaneb Yaseen, Mark Hallett, and Leonardo G. Cohen Human Cortical Physiology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1430
The human motor system undergoes reorganization after amputation, but the site of motor reorganization and the mechanisms involved are unknown. We studied the site and mechanisms of motor reorganization in 16 subjects with traumatic lower-limb amputation. Stimulation at different levels in the CNS was used to determine the site of reorganization. The mechanisms involved were evaluated by measuring the thresholds for transcranial magnetic stimulation (TMS) and by testing intracortical inhibition and facilitation. With TMS, the threshold for muscle activation on the amputated side was lower than that of the intact side, but with transcranial electrical stimulation there was no difference in motor threshold between the two sides. TMS at the maximal output of the stimulator activated a higher percentage of the motor neuron pool (%MNP) on the amputated side than on the intact side. The %MNP activated by spinal electrical stimulation was similar on the two sides. Paired TMS study showed significantly less intracortical inhibition on the amputated side. Our findings suggest that motor reorganization after lower-limb amputation occurs predominately at the cortical level. The mechanisms involved are likely to include reduction of GABAergic inhibition.
Key words: amputation; motor reorganization; mechanisms of plasticity; human; transcranial magnetic stimulation; motor cortex
Copyright © 1998 Society for Neuroscience 0270-6474/98/1893443-08$05.00/0
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