Cerebral Adaptation Associated with Peripheral Nerve Recovery in Neuralgic Amyotrophy: A Randomized Controlled Trial.

"The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article."

"Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Prinses Beatrix Spierfonds [W.OR16-05]. Several authors of this publication are members of the Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD)."

"This study is part of a randomized controlled trial (RCT) investigating the effect of multidisciplinary rehabilitation on residual complaints and cerebral mechanisms in NA, for which the primary outcome measure is functional capability of the upper extremity (quantified with the Shoulder Rating Questionnaire; SRQ). All MRI-compatible RCT participants were included in this sub-study. In this sub-study, the primary objective was to determine if patients with NA have altered cerebral activity related to motor planning of their affected arm, compared to healthy controls and compared to their non-affected arm. To this end, we focused on behavioral performance and cerebral activity associated with the hand laterality judgment task. We originally expected to find changes in parietal and occipital brain regions, as well as postcentral and precentral gyri. These a priori regions of interest (ROIs) were further specified to the right extrastriate cortex and bilateral parieto-occipital sulcus, where we recently found reduced imagery-related brain activity in NA patients versus healthy controls in the baseline measurement. In addition to these ROI analyses, we performed an exploratory whole-brain search. We also included relevant clinical data collected as part of the RCT to relate cerebral adaptations to changes in symptom severity. The clinical data of the full sample of participants will be published in a parallel study. A previous study compared the baseline task-fMRI of the NA patients to a group of healthy participants. The local medical ethical committee (Medical Ethical Committee region Arnhem-Nijmegen, CMO 2017-3740) approved this study and the study is registered at ClinicalTrials.gov (NCT03441347). Conclusions:: Abnormal cerebral sensorimotor representations of the upper extremity after peripheral nerve damage in NA can recover toward normality. As adaptations occurred in visuomotor brain areas, multidisciplinary rehabilitation after peripheral nerve damage may be further optimized by applying visuomotor strategies. This study is registered at ClinicalTrials.gov (NCT03441347)."