Somatosensory and motor representations following bilateral transplants of the hands: A 6-year longitudinal case report on the first pediatric bilateral hand transplant patient

Abstract

A vascularized composite tissue allotransplantation (VCA) was performed at the Children’s Hospital of Philadelphia (CHOP), on an 8-year-old patient in 2015, six years after bilateral hand and foot amputation. Hand VCA resulted in reafferentation of the medial, ulnar, and radial nerves serving hand somatosensation and motor function. We used magnetoencephalography (MEG) to assess somatosensory cortical plasticity following the post-transplantation recovery of the peripheral sensory nerves of the hands. Our 2-year postoperative MEG showed that somatosensory lip representations, initially observed at “hand areas”, reverted to canonical, orthotopic lip locations with recovery of post-transplant hand function. Here, we continue the assessment of motor and somatosensory responses up to 6-years post-transplant. Magnetoencephalographic somatosensory responses were recorded eight times over a six-year period following hand transplantation, using a 275-channel MEG system. Somatosensory tactile stimuli were presented to the right lower lip (all 8 visits) as well as right and left index fingers (visits 3-8) and fifth digits (visits 4-8). In addition, left and right-hand motor responses were also recorded for left index finger and right thumb (visit 8 only).During the acute recovery phase (visits 3 and 4), somatosensory responses of the digits were observed to be significantly larger and more phasic (i.e., smoother) than controls. Subsequent measures showed that digit responses maintain this atypical response profile (evoked-response magnitudes typically exceed 1 picoTesla). Orthotopic somatosensory localization of the lip, D2, and D5 was preserved. Motor beta-band desynchrony was age-typical in localization and response magnitude; however, the motor gamma-band response was significantly larger than that observed in a reference population.These novel findings show that the restoration of somatosensory input of the hands resulted in persistent and atypically large cortical responses to digit stimulation, which remain atypically large at 6 years post-transplant; there is no known perceptual correlate, and no reports of phantom pain. Normal somatosensory organization of the lip, D2, and D5 representation remain stable following post-recovery reorganization of the lip’s somatosensory response.

Publication DOI: https://doi.org/10.1016/j.brainres.2023.148262
Divisions: College of Health & Life Sciences > School of Psychology
Additional Information: Copyright © 2023, The Authors. Published by Elsevier B.V. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License CC BY-NC-ND [https://creativecommons.org/licenses/by-nc-nd/4.0/]
Uncontrolled Keywords: Magnetoencephalography (MEG),Cortical reorganization,Allotransplantation,Neural plasticity,Pediatrics,Sensorimotor oscillations,Vascularised composite allotransplants (VCA)
Publication ISSN: 0006-8993
Last Modified: 20 Jun 2024 07:22
Date Deposited: 14 Feb 2023 10:16
Full Text Link:
Related URLs: https://www.sci ... 032X?via%3Dihub (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2023-04-01
Published Online Date: 2023-01-24
Accepted Date: 2023-01-21
Submitted Date: 2022-11-11
Authors: Gaetz, W
Dockstader, C
Furlong, P L (ORCID Profile 0000-0002-9840-8586)
Amaral, S
Vossough, A
Schwartz, E S
Roberts, T P L
Scott Levin, L

Download

[img]

Version: Published Version

License: Creative Commons Attribution Non-commercial No Derivatives

| Preview

[img]

Version: Accepted Version

Access Restriction: Restricted to Registered users only


Export / Share Citation


Statistics

Additional statistics for this record