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Review
. 2021 Oct 1:8:730367.
doi: 10.3389/fsurg.2021.730367. eCollection 2021.

Understanding Variable Motor Responses to Direct Electrical Stimulation of the Human Motor Cortex During Brain Surgery

Daniel M Aaronson  1 , Eduardo Martinez Del Campo  1 , Timothy F Boerger  1 , Brian Conway  2 , Sarah Cornell  1 , Matthew Tate  3 , Wade M Mueller  1 , Edward F Chang  4 , Max O Krucoff  1   5
Affiliations
Review

Understanding Variable Motor Responses to Direct Electrical Stimulation of the Human Motor Cortex During Brain Surgery

Daniel M Aaronson et al. Front Surg. .

Abstract

Direct electrical stimulation of the brain is the gold standard technique used to define functional-anatomical relationships during neurosurgical procedures. Areas that respond to stimulation are considered "critical nodes" of circuits that must remain intact for the subject to maintain the ability to perform certain functions, like moving and speaking. Despite its routine use, the neurophysiology underlying downstream motor responses to electrical stimulation of the brain, such as muscle contraction or movement arrest, is poorly understood. Furthermore, varying and sometimes counterintuitive responses can be seen depending on how and where the stimulation is applied, even within the human primary motor cortex. Therefore, here we review relevant neuroanatomy of the human motor system, provide a brief historical perspective on electrical brain stimulation, explore mechanistic variations in stimulation applications, examine neurophysiological properties of different parts of the motor system, and suggest areas of future research that can promote a better understanding of the interaction between electrical stimulation of the brain and its function.

Keywords: brain mapping; brain stimulation; cortical plasticity; direct electrical stimulation (DES); motor cortex.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
First sketch mapping motor and sensory responses during an awake craniotomy. Reprinted from Cushing H., A note upon the faradic stimulation of the postcentral gyrus in conscious patients, Brain, 1909;32(1):44–53 by permission of Oxford University Press.
Figure 2
Figure 2
Some motor cortex neurons terminate on spinal cord interneurons, while others terminate directly on motor neurons. The primary motor cortex (M1) is in red, and primary somatosensory cortex (S1) is in blue. Reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Nature Reviews: Neuroscience, Motor cortex—to act or not to act? Christian Laut Ebbesen, et al., 2017.
See this image and copyright information in PMC

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