Our next goal related to the motor representation areas is to compare the location of the optimal TMS site for the thenar muscle in stroke patients with the normal variation determined in StudyI. There is an ongoing project at the Kuopio University Hospital to assess the possible changes in motor representation areas after a stroke.
In the project, the aim is to measure ten recovered stroke patients with a lesion on the primary motor cortex using motor fMRI and TMS. So far, three patients have been measured.
As a continuation to Study II, the method combining cortical thickness with functional information provided by TMS will be applied to other patient populations as well. Furthermore, combining fMRI results with cortical thickness analysis and/or with TMS parameters is another application worth investigating to gain more information about different diseases.
The largest and inevitable limitation of StudyIIIwas that the laterality provided
Discussion
by the fMRI could not be validated using other techniques, such as the Wada test, because the study used healthy volunteers. Therefore, we wanted to repeat the study with patients selected for an operative treatment and undergoing the Wada testing.
So far, twelve patients with epilepsy have participated in the study. The patient data provide the information required to compare the results of the LI with those of the Wada test. As another continuation to the study, the fMRI results are used to guide rTMS to study speech and language areas. The goal is to specify which brain areas activated in fMRI are essential to language processing and which are contributory.
Our next project in studying the single-trial functional connectivity is to evaluate the aPCA method with more subjects and with more slices to cover the frontal lobes as well. The frontal areas are known to be responsible for the execution of the motor commands, which should produce interesting differences in functional connectivity patterns between the target and standard events. Furthermore, the aPCA method should be tested with other paradigms and with different inter-stimulus intervals.
9 Summary and Conclusions
In the present study, non-invasive and robust methods to map and study the function of the brain areas related to primary motor functions as well as speech and language were developed. In particular, the usefulness of combinations of different modalities or approaches were assessed in developing new methodologies that either are suitable for use in clinics or provide new tools for research.
The main findings of this thesis can be summarized as follows:
• Navigated TMS combined with MR image normalization can be used to define normal variation in the location of brain motor function.
• The methodology for normalizing the optimal TMS sites presented in this thesis could be used to study the location of functional representation areas of muscles or other functionally active cortical areas, as well as any differences in them caused by disease, learning or experience.
• A combination of navigated TMS and the cortical thickness analysis provides detailed information on neurodegenerative diseases and their influence on various cortical areas.
• A suitable fMRI task battery for defining language laterality for Finnish-speaking subjects combines three different language tasks: word generation, responsive naming and sentence comprehension.
• The language laterality index calculated using the fMRI results is highly dependent on the language task used, and on whether the calculation is based on a single task or on a combination of several tasks.
• Using the augmented PCA method it is possible to analyze single-trial con-nectivity between cortical areas. The method produces reasonable task-level connectivity maps and allows the examination of variability in single-trial connectivity due to changes in subjects’ attention and/or alertness.
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