RESEARCH ARTICLE
Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy Vagner Wilian Batista e Sá1,2,3☯*, Maria Katia Gomes2☯, Maria Luíza Sales Rangel3, Tiago Arruda Sanchez2, Filipe Azaline Moreira2, Sebastian Hoefle3,4, Inaiacy Bittencourt Souto2, Antônio José Ledo Alves da Cunha2, Ana Paula Fontana2☯, Claudia Domingues Vargas3,5☯¤* 1 Núcleo de Pesquisas em Fisioterapia, Universidade Castelo Branco, Rio de Janeiro, Rio de Janeiro, Brazil, 2 Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil, 3 Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil, 4 Cognitive and Behavioral Neuroscience Unit and Neuroinformatics Workgroup, D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil, 5 Instituto de Neurologia Deolindo Couto da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
OPEN ACCESS Citation: Batista e Sá VW, Gomes MK, Rangel MLS, Sanchez TA, Moreira FA, Hoefle S, et al. (2015) Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy. PLoS Negl Trop Dis 9 (7): e0003944. doi:10.1371/journal.pntd.0003944 Editor: Carlos Franco-Paredes, Emory University, UNITED STATES Received: May 16, 2015 Accepted: July 1, 2015 Published: July 23, 2015 Copyright: © 2015 Batista e Sá et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was funded by Conselho Nacional de Desenvolvimento Cientifico e tecnológico CNPq (grant numbers 306817/2014-4 and 480108/2012-9). CDV and AJLAdC are also supported by Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro FAPERJ (grant E26/ 110.526/2012 and E-26/102.931/2011 respectively). CDV is supported by Financiadora de Estudos e projetos FINEP (PROINFRA HOSPITALAR grant 18.569-8). This work is also part of the Fundação de Amparo a Pesquisa do Estado de São Paulo
☯ These authors contributed equally to this work. ¤ Current address: Centro de Ciências da Saúde, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil * [email protected] (VWBeS); [email protected] (CDV)
Abstract Background Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS).
Methods In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p50 μV/ MEP. The muscle overlap parameter was defined as the TMS stimulation points that generated simultaneous MEPs in all four-target muscles [51,50].
Data Analysis Descriptive and nonparametric analyses were performed using STATISTICA 7.0 (StatSoft Inc., Tulsa, USA) and GraphPad Prism 6 (GraphPad Software, Inc.,San Diego, USA). To study the handgrip (dynamometry), TMS map area and COG we used a Wilcoxon matched-pairs signed rank test. The Mann-Whitney test was chosen to analyze the TMS motor threshold and MEP amplitudes. For all statistical tests, the alpha level was set to p
Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy Vagner Wilian Batista e Sá1,2,3☯*, Maria Katia Gomes2☯, Maria Luíza Sales Rangel3, Tiago Arruda Sanchez2, Filipe Azaline Moreira2, Sebastian Hoefle3,4, Inaiacy Bittencourt Souto2, Antônio José Ledo Alves da Cunha2, Ana Paula Fontana2☯, Claudia Domingues Vargas3,5☯¤* 1 Núcleo de Pesquisas em Fisioterapia, Universidade Castelo Branco, Rio de Janeiro, Rio de Janeiro, Brazil, 2 Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil, 3 Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil, 4 Cognitive and Behavioral Neuroscience Unit and Neuroinformatics Workgroup, D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil, 5 Instituto de Neurologia Deolindo Couto da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
OPEN ACCESS Citation: Batista e Sá VW, Gomes MK, Rangel MLS, Sanchez TA, Moreira FA, Hoefle S, et al. (2015) Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy. PLoS Negl Trop Dis 9 (7): e0003944. doi:10.1371/journal.pntd.0003944 Editor: Carlos Franco-Paredes, Emory University, UNITED STATES Received: May 16, 2015 Accepted: July 1, 2015 Published: July 23, 2015 Copyright: © 2015 Batista e Sá et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was funded by Conselho Nacional de Desenvolvimento Cientifico e tecnológico CNPq (grant numbers 306817/2014-4 and 480108/2012-9). CDV and AJLAdC are also supported by Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro FAPERJ (grant E26/ 110.526/2012 and E-26/102.931/2011 respectively). CDV is supported by Financiadora de Estudos e projetos FINEP (PROINFRA HOSPITALAR grant 18.569-8). This work is also part of the Fundação de Amparo a Pesquisa do Estado de São Paulo
☯ These authors contributed equally to this work. ¤ Current address: Centro de Ciências da Saúde, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil * [email protected] (VWBeS); [email protected] (CDV)
Abstract Background Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS).
Methods In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p50 μV/ MEP. The muscle overlap parameter was defined as the TMS stimulation points that generated simultaneous MEPs in all four-target muscles [51,50].
Data Analysis Descriptive and nonparametric analyses were performed using STATISTICA 7.0 (StatSoft Inc., Tulsa, USA) and GraphPad Prism 6 (GraphPad Software, Inc.,San Diego, USA). To study the handgrip (dynamometry), TMS map area and COG we used a Wilcoxon matched-pairs signed rank test. The Mann-Whitney test was chosen to analyze the TMS motor threshold and MEP amplitudes. For all statistical tests, the alpha level was set to p
