Some long-term motor effects of cerebral commissurotomy in man

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Abstract

The long-term effects of cerebral commissurotomy on motor co-ordination and dyspraxia were investigated in 8 patients who had undergone complete or partial commissurotomy 5–10 yr previously. Performance on a series of standardized motor co-ordination and manual dexterity tests was compared with the established norms. Although qualitative performance appeared essentially unimpaired on most tests the scores for speed were consistently below normal and also inferior to those reported for patients with various unilateral brain lesions. In certain bimanual tasks requiring rapid alternating motion and interdependent control severe qualitative and quantitative impairments were present. In addition, marked dysgraphia and mild ideomotor-type dyspraxia on the left side, and moderate dyscopia on the right were present up to 10 yr after surgery in patients with complete commissurotomy. It would appear from the results that interhemispheric communication becomes particularly important for motor output to the extent that the tasks involve complex intermanual coordination or hemispheric specialization with ipsilateral control.

Résumé

On a étudié les effets à long terme de la commissurotomie cérébrale sur la coordination motrice et la dyspraxie chez 8 malades ayant subi une commissurotomie compléte ou partielle, 6–10 ans auparavant. On a comparé leur performance à une série d'épreuves standardisées de coordination motrice et de dextérité manuelle avec les normes établies préalablement. Bien que la performance apparaisse au plan qualitatif essentiellement intacte à la plupart des tests, les scores de rapiditéétaient de façon cohérente au dessous de la normale et également inférieurs à ceux rapportés pour les malades atteints de lésions cérébrales unilatérales diverses. Dans certaines tâches bimanuelles exigeant un mouvement alternatif rapide et un contrôle interdépendent, on constatait des troubles graves à la fois sur les plans qualitatif et quantitatif. En outre, chez les malades avec commissurotomie compléte, on observait une dysgraphie nette et dyspraxie légère de type idéomoteur du côté gauche ainsi une dyscopie modérée à droite et ceci jusqu'à 10 ans aprés la chirurgie. De ces résultats, il ressort que la communication interhémisphérique devient particuliérement importante pour la sortie motrice si l'épreuve réclame une coordination intermanuelle complexe ou une spécialisation hémisphérique avec contrôle ipsilatéral.

Zusammenfassung

Bei 8 Patienten, die sich sechs bis zehn Jahre zuvor einer kompletten oder partiellen Kommissurotomie unterzogen hatten, wurden die Auswirkungen der cerebralen Kommissurotomie auf motorische Koordination und Dyspraxie untersucht. Die Leistungen bei einer Serie standardisierter Tests zur motorischen Koordination und Händigkeit wurde mit Normwerten verglichen. Obwohl die qualitative Leistung bei den meisten Tests im wesentlichen ungestört wirkte, waren die Leistungen in Bezug auf Geschwindigkeit übereinstimmend unter der Norm und auch unter den Ergebnissen, die von Patienten mit verschiedenen unilateralen Hirnläsionen erzielt werden. Bei gewissen bimanuellen Aufgaben, die rasche wechselnde Bewegung und gegenseitige Kontrolle verlangen, zeigten sich schwere qualitative und quantitative Beeinträchtigungen. Auβerdem waren ausgeprägte Dysgraphie und leichte ideokinetische Dyspraxie auf der linken Seite und mäβige Dyskopie auf der rechten Seite bis zu 10 Jahren nach der Operation bei den Patienten mit kompletter Kommissurotomie nachweisbar. Nach diesen Ergebnissen scheint die interhemisphärische Kommunikation besonders wichtig für den motorischen output zu sein, und zwar insbensondere bei den Aufgaben, die komplexe intermanuelle Koordination oder hemisphärische Spezialisierung mit ipsilateraler Kontrolle verlangen.

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    Supported by Grant No. 03372 from the National Institutes of Mental Health of the United States Public Health Service and by the F.P. Hixon Fund of the California Institute of Technology.

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