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Biomedical subjects

H J Freund

Publications and source records attributed to H J Freund.

At least 73 records · Page 4Linked to original sources
PubMed1998

Precentral glioma location determines the displacement of cortical hand representation.

OBJECTIVE: Low-grade brain tumors may remain asymptomatic in contrast to malignant gliomas. The mechanisms underlying the preservation of cerebral function in such gliomas are not well understood. METHODS: We used positron emission tomography and transcranial magnetic stimulation for presurgical monitoring of motor hand function in six patients with gliomas of the precentral gyrus. All patients were able to perform finger movements of the contralesional hand. RESULTS: Movement-related increases of the regional cerebral blood flow occurred only outside the tumor in surrounding brain tissue. Compared with the contralateral side, these activations were shifted by 20 +/- 13 mm (standard deviation) within the dorsoventral dimension of the precentral gyrus. This shift of cortical hand representation could not be explained by the deformation of the central sulcus as determined from the spatially aligned magnetic resonance images but was closely related to the location of the maximal tumor growth. Dorsal tumor growth resulted in ventral displacement of motor hand representation, leaving the motor cortical output system unaffected, whereas ventral tumor growth leading to dorsal displacement of motor hand representation compromised the motor cortical output, as evident from transcranial magnetic stimulation. In two patients, additional activation of the supplementary motor area was present. CONCLUSION: Our data provide evidence for the reorganization of the human motor cortex to allow for preserved hand function in Grade II astrocytomas.

Adult↗
PubMed1998

Human anterior intraparietal area subserves prehension: a combined lesion and functional MRI activation study.

It has been shown in nonhuman primates that the posterior parietal cortex is involved in coordination of arm and eye movements in space, whereas the anterior intraparietal area in the anterior lateral bank of the intraparietal sulcus plays a crucial role in fine finger movements, such as grasping. In this study we show by optoelectronic movement recordings that patients with cortical lesions involving the anterior lateral bank of the intraparietal sulcus have selective deficits in the coordination of finger movements required for object grasping, whereas reaching is much less disturbed. Patients with parietal lesions sparing the cortex lining the anterior intraparietal sulcus showed intact grasping behavior. Complementary evidence was obtained from functional MRI in normal control subjects showing a specific activation of the anterior lateral bank of the intraparietal sulcus during grasping. In conclusion, this combined lesion and activation study suggests that the anterior lateral bank of the intraparietal sulcus, possibly including the human homologue of the anterior intraparietal area, mediates the processing of sensorimotor integration of precisely tuned finger movements in humans.

Adult↗
PubMed1996

Thalamic metbolism and corticospinal tract integrity determine motor recovery in stroke.

We studied the role of remote metabolic depressions and pyramidal tract involvement regarding motor recovery following a first hemiparetic ischemic stroke. In 23 patients the regional cerebral glucose metabolism (rCMRGlu) was measured with positron emission tomography and the location and spatial extent of the stroke lesions were assessed by magnetic resonance imaging. Motor impairment during the acute and chronic stages (4 weeks after stroke) was determined by a motor score and recordings of magnetic evoked motor potentials. Twelve patients recovered significantly, whereas 11 patients retained a disabling hemiparesis. In contrast to patients with good motor recovery, rCMRGlu was severely depressed in the thalamus on the lesion side in patients with poor motor recovery. This patient group also showed more severe damage to the pyramidal tract on magnetic resonance images and a more pronounced reduction of the magnetic evoked motor potential amplitude. Neither the size of the stroke lesions nor the spatial extent of the lesional and remote rCMRGlu depressions outside the thalamus correlated with the thalamic hypometabolism and the improvement of the motor score. We conclude that preservation both of parts of the pyramidal tract and of the thalamic circuitry is a major determinant for the quality of hand motor recovery following acute brain ischemia in the adult.

Adult↗
PubMed1996

Virtual holography in diagnosis and therapy of sensorimotor disturbances.

It has been shown that VR techniques can be usefully applied in the field of sensorimotor disturbances. Virtual scenarios can be created in which patients perform specific motor tasks. Using an optoelectronic position tracking system for motion recording as well as for interaction with virtual objects, and using Virtual Holography as an adequate visualization technique, we are now developing and testing suitable scenarios. Furthermore, an advanced visualization and animation tool using VR technology for diagnosis purpose and therapy planning has been developed, which the physician can profit from during motion analysis.

Computer Graphics↗
PubMed1996

Basal ganglia and cerebellar impairment differentially affect the amplitude and time scaling during the performance of forearm step tracking movements.

Forearm step tracking movements of different amplitudes were analysed in nine patients with cerebellar and five patients with parkinsonian symptoms in comparison to six normal subjects. Movements were made under two instructions: 1) track "as fast as possible" and 2) "as precisely as possible". Movement duration, acceleration duration and peak velocity increased with increasing amplitude. The ratio between acceleration and deceleration duration was independent of movement amplitude in the parkinsonian patients and the normal subjects. In the cerebellar patients, however, this ratio decreased with increasing amplitude. This impairment of the relative timing between acceleration and deceleration duration implies that, in contrast to parkinsonian patients, cerebellar patients cannot anymore utilize physiological scaling mechanisms when performing movements of different amplitudes.

Adult↗
PubMed1995

Modulation of somatosensory evoked magnetic fields by sensory and motor interferences.

Modulatory influences of skilled exploratory finger movements on somatosensory evoked magnetic fields evoked by median nerve stimulation were investigated in six healthy subjects using a whole head magnetometer (MEG) system. The exploratory finger movements caused major changes in the somatosensory evoked fields. The most prominent effect was a reversal of the dipolar magnetic field around 30 ms after median nerve stimulation. Similar but less pronounced effects were exerted by repetitive finger movements and tactile stimulation of the hand. A dipole analysis and super-imposition of resulting sources on individual MRI scans showed that all somatosensory evoked fields up to 60 ms after stimulation, and the modulation of these responses were located in the primary somatosensory cortex (SI).

Adult↗
PubMed1995

Ataxic breathing during alternating forearm movements of various frequencies in cerebellar patients.

Breathing was analyzed at rest and during sinusoidal tracking movements of the forearm of the dominant side at various frequencies in 11 patients with a cerebellar impairment and in 9 healthy subjects. In the patients, breathing movements were always rhythmical as in normal subjects during rest, but sometimes were interrupted by intermittent breathing-arrests during tracking (breathing ataxia). In 9 of the 11 cerebellar patients, the normal phase relationships between breathing and forearm movements at target frequencies in the spontaneous breathing rate range were absent. Thus patients with cerebellar lesions not only show disturbed skeletomotor movements, but also show an impaired coordination between breathing and limb movements.

Adult↗
PubMed1995

Large-scale plasticity of the human motor cortex.

The adult primate brain is capable of modifying rapidly the size of cortical receptive fields or motor output modules in response to altered synaptic input. We used positron emission tomography (PET) to map the regional cerebral blood flow changes related to voluntary finger movements in patients with tumours occupying the hand area of motor cortex. All patients showed activations solely outside the tumour. Compared with the unaffected side, the activations were shifted by 9-43 mm either along the mediolateral body representation of motor cortex or into premotor or parietal somatosensory cortex. These results provide evidence that slowly developing lesions can induce large-scale reorganization that is not confined to changes within the somatotopic body representation in motor cortex.

Adult↗
PubMed1995

Subcortical origin of visuomotor apraxia.

Visuomotor apraxia (VMA) is a clinical syndrome characterized by a failure to make use of visual information when performing a target-directed movement. Visuomotor apraxia has traditionally been assumed to result from a disconnection of cortico-cortical fibres between visual and motor areas following occipito-parietal lesions. We describe a patient who developed a permanent contralesional and a temporary ipsilesional visuomotor apraxia as part of a complex neurological syndrome after a right [corrected] thalamic haemorrhage. MRI showed that the suprathalamic white matter was not involved but the most caudal fibres of the internal capsule appeared to be interrupted. To our knowledge this is the first case of a VMA with a lesion restricted to a deep subcortical area indicating that VMA can result from damage to subcortical projections rather than interruption of cortico-cortical fibres.

Aged↗
PubMed1995

Somatosensory evoked potentials elicited by intraneural microstimulation of afferent nerve fibers.

Cortical somatosensory evoked potentials (SEPs) after intraneural microstimulation (IMS) of cutaneous and afferent muscle nerve fibers in the median nerve were recorded to study the contribution of different afferent fiber groups to the SEP. Thirty-seven cutaneous fiber bundles, 10 afferent muscle nerve fiber bundles, and 45 single mechanoreceptive afferents of FA I- (n = 12), FA II- (n = 8), SA I- (n = 13), and SA II-type (n = 12) were studied in 29 healthy subjects. IMS of cutaneous fiber bundles evoked cortical responses corresponding to the N20 component after median nerve stimulation in 86% of the fascicles studied, whereas IMS of muscle nerve fiber bundles elicited responses only in 20%. After IMS of single mechanoreceptive afferents of FA I-, FA II-, and SA I-type cortical responses were obtained in all groups in approximately 80% of the stimulated units. The latencies of the SEPs evoked by IMS were comparable to that after compound median nerve stimulation (mean difference 0.58 ms). The N20 amplitudes of SEPs after IMS of cutaneous fiber bundles were on average 28% (n = 32) and for single afferents 22% (n = 30) of that after compound nerve stimulation. It is concluded that the median nerve SEPs evoked by compound median nerve stimulation of the resting hand are dominated by cutaneous rather than muscle afferent input. Furthermore, the fact that selective stimulation of only a few cutaneous afferents produces cortical SEPs of rather high amplitude is compatible with the view that sensory information produced by selective afferent stimulation is differentially gated into the somatosensory cortex.

Adult↗