Application of navigated transcranial magnetic stimulation to map the supplementary motor area in healthy subjects
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Supplementary motor area
Motor area
Supplementary motor area
Motor area
Human brain
Stimulus (psychology)
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Supplementary motor area
Motor area
Stimulus (psychology)
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Abstract Background The supplementary motor area (SMA) is involved in planning of voluntary motor activities. Tumors in SMA usually present with seizures and, rarely, motor deficits. Postoperatively, these patients may develop SMA syndrome. Patients with SMA tumors usually undergo awake craniotomy along with neuromonitoring for maximal safe resection, and some of these patients tend to have residual tumor. Objective To completely excise the SMA region tumors under general anesthesia without causing any permanent neurological deficits. Methods We operated upon four patients with SMA region tumor under general anesthesia (GA) with direct electrocortical stimulation (DES). Motor-evoked potential was used to monitor corticospinal tracts through corkscrew or strip electrodes. Intraoperative MRI was done to assess the tumor excision. Results All four patients had complete resection of tumor and, postoperatively, all four developed SMA syndrome. All of them recovered completely over a period of time. Conclusion SMA tumors can be excised completely under GA with DES, thereby increasing progression-free survival.
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Structured abstract Background Damage to the supplementary motor area (SMA) for example during surgery can lead to impairments of motor and language function. A detailed preoperative mapping of functional boarders of the SMA could therefore aid preoperative diagnostics in these patients. Objective The aim of this study was the development of a repetitive nTMS protocol for non-invasive functional mapping of the SMA while assuring effects are indeed caused by SMA stimulation rather than activation of M1. Methods To this purpose the SMA in the dominant hemisphere of twelve healthy subjects (28.2 ± 7.7 years, 6 females) was mapped using repetitive nTMS at 20 Hz (120% RMT), while subjects performed a finger tapping task. The location of induced errors was marked in each subject’s individual MRI. To further validate the protocol, effects of SMA stimulation were directly compared to effects of M1 stimulation in four different tasks. Results Mapping of the SMA was possible for all subjects, yet varying effect sizes were observed. Stimulation of the SMA led to a significant reduction of finger taps compared to baseline (BL: 45 taps, SMA: 35.5 taps; p < 0.01). Line tracing, writing and targeting of circles was less accurate during SMA compared to M1 stimulation. Conclusion Mapping of the SMA using repetitive nTMS is feasible. While errors induced in the SMA are not entirely independent of M1 due to the proximity of both regions, disruption of the SMA induces functionally distinct errors. These error maps can aid preoperative diagnostics in patients with SMA related lesions.
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Supplementary motor area
Motor area
Premotor cortex
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The supplementary motor area (SMA) is a key structure involved in behavioral planning and execution. Although many reports have indicated that SMA is organized somatotopically, its exact organization remains still unclear. This study aimed to functionally map SMA using functional magnetic resonance imaging (fMRI) and validate the fMRI-SMA by electrocortical stimulation (ECS) and postsurgical symptoms. Total 32 healthy volunteers and 24 patients participated in this study. Motor tasks were right and left finger tapping and language tasks included simple reading, lexical decision for presented words, and verb generating tasks. SPM8 was used to conduct individual and group analyses. In all subjects, the lexical decision task induced the greatest number of active fMRI pixels in SMA. fMRI during the language tasks showed anterior part of SMA compared to finger tapping tasks. We found an overlap spot with all different tasks in posterior part of SMA, which we termed SMA core. Six patients underwent awake craniotomy for ECS mapping for primary regions and SMA. During awake craniotomy, ECS to posterior part of SMA, which might involve the possible SMA core consistently, evoked both speech arrest and flaccid hemiparesis. The SMA mapping suggested posterior part of SMA might play more important roles in any executions, which might involve the SMA core.
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The supplementary motor area (SMA-proper) is important for the programming and execution of motor, speech, and other elaborative functions. SMA is frequently involved by brain tumors (particularly WHO grade II gliomas). Surgery in this area can be followed by the 'SMA syndrome', characterised by contralateral akinesia and mutism. We present a case of Falcine meningioma in the region of the right SMA which developed SMA syndrome. Our patient showed complete recovery of neurological function but the process was slow with a specific pattern.
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The supplementary motor area (SMA) is a region located within each cerebral hemisphere at the posterior medial border of the frontal lobe. It is considered to play an important role in planning, initiating and maintaining sequential motor actions. In this report, we aimed to confirm or invalidate the somatotopic organization of the SMA, correlates the pattern of clinical symptoms observed after SMA removal with the extent of resection. Althogh there was no apparent change shown in the monitoring of intraoperative motor evoked potential (MEP), four patients displayed postoperative SMA syndrome on the side of the body contralateral to the SMA resection. All patients developed postoperative severe hemiplegia. One dominant frontal glioma patient was followed by transient mutism and motor aphasia. In this study, there is no correlation between extent of SMA resection and postoperative clinical pattern of deficits.
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Frontal lobe
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ABSTRACT BACKGROUND AND PURPOSE We examined the resting‐state functional connectivity (RSFC) of the supplementary motor area (SMA) in brain tumor patients. We compared the SMA subdivisions (pre‐SMA, SMA proper, central SMA) in terms of RSFC projected from each region to the motor gyrus and language areas. METHODS We retrospectively identified 14 brain tumor patients who underwent task‐based and resting‐state fMRI, and who completed motor and language paradigms that activated the SMA proper and pre‐SMA, respectively. Regions of interest (ROIs) obtained from task‐based fMRI were generated in both areas and the central SMA to produce RSFC maps. Degree of RSFC was measured from each subdivision to the motor gyrus and Broca's area (BA). RESULTS All patients showed RSFC between the pre‐SMA and language centers and between the SMA proper and motor gyrus. Thirteen of 14 patients showed RSFC from the central SMA to both motor and language areas. There was no significant difference between subdivisions in degree of RSFC to BA (pre‐SMA, r = .801; central SMA, r = .803; SMA proper; r = .760). The pre‐SMA showed significantly less RSFC to the motor gyrus ( r = .732) compared to the central SMA ( r = .842) and SMA proper ( r = .883) ( P = .016, P = .001, respectively). CONCLUSIONS The region between the pre‐SMA and SMA proper produces reliable RSFC to the motor gyrus and language areas in brain tumor patients. This study is the first to examine RSFC of the central SMA in this population. Consequently, our results provide further validation to previous studies, supporting the existence of a central SMA with connectivity to both motor and language networks.
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Superior frontal gyrus
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Supplementary motor area
Motor Learning
Sequence (biology)
Motor area
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