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OBJECTIVEThe aim of the present study was to evaluate the usefulness of navigated transcranial magnetic stimulation (nTMS) as a prognostic predictor for upper-extremity motor functional recovery from postsurgical neurological deficits.METHODSPreoperative and postoperative nTMS studies were prospectively applied in 14 patients (mean age 39 ± 12 years) who had intraparenchymal brain neoplasms located within or adjacent to the motor eloquent area in the cerebral hemisphere. Mapping by nTMS was done 3 times, i.e., before surgery, and 1 week and 3 weeks after surgery. To assess the response induced by nTMS, motor evoked potential (nTMS-MEP) was recorded using a surface electromyography electrode attached to the abductor pollicis brevis (APB). The cortical locations that elicited the largest electromyography response by nTMS were defined as hotspots. Hotspots for APB were confirmed as positive responsive sites by direct electrical stimulation (DES) during awake craniotomy. The distances between hotspots and lesions (DHS-L) were measured. Postoperative neurological deficits were assessed by manual muscle test and dynamometer. To validate the prognostic value of nTMS in recovery from upper-extremity paresis, the following were investigated: 1) the correlation between DHS-L and the serial grip strength change, and 2) the correlation between positive nTMS-MEP at 1 week after surgery and the serial grip strength change.RESULTSFrom the presurgical nTMS study, MEPs from targeted muscles were identified in 13 cases from affected hemispheres. In one case, MEP was not evoked due to a huge tumor. Among 9 cases from which intraoperative DES mapping for hand motor area was available, hotspots for APB identified by nTMS were concordant with DES-positive sites. Compared with the adjacent group (DHS-L < 10 mm, n = 6), the nonadjacent group (DHS-L ≥ 10 mm, n = 7) showed significantly better recovery of grip strength at 3 months after surgery (p < 0.01). There were correlations between DHS-L and recovery of grip strength at 1 week, 3 weeks, and 3 months after surgery (r = 0.74, 0.68, and 0.65, respectively). Postsurgical nTMS was accomplished in 13 patients. In 9 of 13 cases, nTMS-MEP from APB muscle was positive at 1 week after surgery. Excluding the case in which nTMS-MEP was negative from the presurgical nTMS study, recoveries in grip strength were compared between 2 groups, in which nTMS-MEP at 1 week after surgery was positive (n = 9) or negative (n = 3). Significant differences were observed between the 2 groups at 1 week, 3 weeks, and 3 months after surgery (p < 0.01). Positive nTMS-MEP at 1 week after surgery correlated well with the motor recovery at 1 week, 3 weeks, and 3 months after surgery (r = 0.87, 0.88, and 0.77, respectively).CONCLUSIONSNavigated TMS is a useful tool for identifying motor eloquent areas. The results of the present study have demonstrated the predictive value of nTMS in upper-extremity motor function recovery from postsurgical neurological deficits. The longer DHS-L and positive nTMS-MEP at 1 week after surgery have prognostic values of better recovery from postsurgical neurological deficits.

Action disorganization syndrome (ADS) is a frontal lobe neuropsychological syndrome characterized by deficits in the performance of familiar sequential tasks such as making a cup of tea. In this study, we examined the performance of familiar sequential tasks by 3 patients with right frontal brain tumours and no other areas of brain damage. When task-irrelevant objects were presented as distractors in addition to the target objects, all patients used the distractors in accordance with the target task. These patients showed few of the sequential and omission errors that had been previously reported in patients with ADS. Although normal participants could suppress the activation of task-irrelevant objects, these patients had difficulty with this process, which would normally be carried out by the right frontal lobe to determine the most suitable action behaviour. The intact left frontal lobe may receive bottom-up activation from the distractors and modify this schema to match the behavioural context. Our findings suggest that patients with only right frontal lobe damage may be characterized more by action disinhibition than by disorganization.

Background. Perseveration has been observed in a number of behavioural contexts, including speaking, writing, and drawing. However, no previous report describes patients who show perseveration only for drawing a human figure.Objective. The present report describes a group of patients who show body awareness-related cognitive impairment during a human figure drawing task, a different presentation from previously described neuropsychological cases.Methods. Participants were 15 patients who had a frontal lobe brain tumour around the insula cortex of the right hemisphere and had subsequently undergone a neurosurgical resective operation. Participants were asked to draw a human figure in both “hands-down” and “hands-up” configurations.Results. Eight of the 15 patients drew a human figure with six fingers during the “hands-up” and the “hands-down” human figure drawing tasks (one patient drew eight fingers). A statistical analysis of potential lesion areas revealed damage to the right anterior frontal insula and operculum in this group of patients relative to the five-finger drawing group.Conclusions. Our findings reveal a newly described neuropsychological phenomenon that could reflect impairment in attention directed towards body representations.

MRI is used not only for anatomical location and characterization but also for 3D views of sulci and gyri. T1WI-MRI captured with 3D-volume acquired 3D-views of sulci and gyri on fifty healthy volunteers and two patients. The software that we developed analyzed and labeled sulcal patterns of cerebral cortex automatically comparing to a standard brain model. We focused the post-central sulcus (PoC) and 2 neighboring sulci with an inter-sulcal analysis (Relations) including an inter-sulci junction (PoC and cingulate sulcus posterior [Cing]). The value of PoC-Cing Relations of focal cortical dysplasia (FCD) is higher than that of normal, while the value of glioma is much less among that of normal. The PoC of FCD and a few normal brains have junction with Cing. This informative value and a presence of inter-sulci junction suggest that cortical folding dynamics might influence the folding patterns of cerebral cortex. This sulcal labeling can analyze normal and abnormal patient’s brains for clinical use.