Title: Transcranial magnetic stimulation follow up of brachial plexus palsies in adults after complex microsurgical reconstructions

Abstract:

Introduction
In adult postsurgical brachial plexus (BP) injuries, transcranial magnetic stimulation (TMS) imaging of the cortical area may reveal active neuroplasticity events that depend on rehabilitation therapy (RT) compliance.
Material and Methods
On the right (dominant) arm of two patients with chronic BP lesions, we retrospectively evaluated the course of functional recovery. The medical histories of both patients included numerous microsurgical treatments for muscle transfer and neurotization. Using a 4-axis pattern, TMS was used to map the motor area of the limb and measure the amplitudes of the motor evoked potentials (MEP). The patients were tested twice, with the second assessment performed after RT had just concluded, specifically using Proprioceptive Neuromuscular Facilitation (PNF) and Neuromuscular Electrical Stimulation (NEMS).
Results
Changes occurred in the motor region during the TMS assessment. Within both cervical and cortical area of the left cerebral hemisphere, higher MEP amplitudes were linked to improved MEP latency. The best results showed an increase in MEP amplitude for both patients (from 1.08 mV to 1.49 mV and lowered latencies from 37.1 msec to 36.3 msec; from 1.35 mV to 1.98 mV and decrease of latencies from 39.2 msec to 37.9 msec, respectively).
Discussion
Whereas the limitations induced by the small sample size, the outcomes show cortical area reactivity with respect to treatment modalities.
Conclusions
The demand for long-term commitment to treatment guidelines is supported by the evidence of ongoing brain activity.

Biography:

Prof. Dr. Teodor Stamate is Emeritus Professor of Plastic, Aesthetic and Reconstructive Microsurgery, from the University of Medicine and Pharmacy "Grigore T. Popa" Iași, Romania. The Founder of multiple national associations, such as The Romanian Society of Reconstructive Surgery and the Romanian Society of Hand Surgery, is former Chief of the Plastic, Aesthetic and Reconstructive Microsurgery Department of the Emergency Hospital "Sf. Spiridon” in Iași. Prof. Dr. Teodor Stamate is also a well-recognized promotor of novel microsurgical techniques in Romania, as well as author and researcher, PhD coordinator and distinguished member of the prestigious Academy of Medical Sciences.