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Reorganization of Bilateral Control in Motor Cortex after Peripheral Nerve Crossing
Su Jiang, MD
Fudan University, Shanghai, China

Objective: The results of treating upper extremity spastic paralysis, one of the most serious sequelae of severe CNS injury, are far from satisfactory due to limited fibers in the ipsilateral pathway. We conducted a peripheral nerve crossing surgery to increase the ipsilateral control of the hemiplegia limb by transferring 20% of the contralateral fibers to the ipsilateral side, generating a unique model in which both upper extremities are innervated simultaneously by one hemisphere.
Methods: After CCI injury of the left motor cortex in Thy1-ChR2-EYFP transgenic mice, peripheral nerve crossing surgery (CC7) were performed. These mice were subjected to behaviorial tests to evaluate motor recovery of bilateral upper limb function and in vivo optogenetic-electromyography examination to map the dynamic changes at different stages postsurgery.
Results: For mice model of the CCI, the surgery caused higher score of the contralateral forelimb in rotarod and skilled walking tests after 5-month post-surgery. In vivo electromyography studies revealed that optogenetic stimulation of the intact motor cortex could evoke potentials in the bilateral triceps and forelimb extensors after 5-month and 7-month postsurgery, respectively. During this period, the cortical representations of the ipsilateral triceps and forelimb extensors shrinked gradually and moved close to the cortical representations of contralateral muscles.
Conclusion: Peripheral nerve crossing could promote the functional recovery of contralateral upper extremity in mice with severe CCI. The intact hemisphere dynamically participates in controlling movements of the bilateral upper limbs. Such surgery could be a potential novel application in clinical treatment of brain injury.

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