Brain, Vol. 122, No. 2, 351-368,
February 1999
© 1999 Oxford University Press
The role of ventral medial wall motor areas in bimanual co-ordination
A combined lesion and activation study
1 Departments of Neurology and 2 Anatomy and 3 C.u.O. Vogt Institute, Heinrich-Heine-University of Düsseldorf, 4 Institute of Medicine, FZJ Forschungzentrum Jülich and 5 Department of Stereotactic Neurosurgery, University of Cologne, Germany
Correspondence to:
Dr K. M. Stephan, Neurologische Universitätsklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
Two patients with midline tumours and disturbances of bimanual co-ordination as the presenting symptoms were examined. Both reported difficulties whenever the two hands had to act together simultaneously, whereas they had no problems with unimanual dexterity or the use of both hands sequentially. In the first patient the lesion was confined to the cingulate gyrus; in the second it also invaded the corpus callosum and the supplementary motor area. Kinematic analysis of bimanual in-phase and anti-phase movements revealed an impairment of both the temporal adjustment between the hands and the independence of movements between the two hands. A functional imaging study in six volunteers, who performed the same bimanual in-phase and anti-phase tasks, showed strong activations of midline areas including the cingulate and ventral supplementary motor area. The prominent activation of the ventral medial wall motor areas in the volunteers in conjunction with the bimanual co-ordination disorder in the two patients with lesions compromising their function is evidence for their pivotal role in bimanual co-ordination.
medial wall motor areas; cingulate motor areas; supplementary motor area; bimanual interaction; neuroimaging
FFT = fast Fourier transform; fMRI = functional MRI; rCBF = regional cerebral blood flow; SMA = supplementary motor area; SPM = statistical parametric mapping
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