Nobbs, David Robert Henry; (2018) Upper limb movement after hemispherectomy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Hemispherectomy is a surgical procedure for treating intractable epilepsy, involving the removal or disconnection of a cerebral hemisphere. Prior to surgery, patients have weakness along one side of their body and disruptions to their motor control. These impairments can be further exacerbated by the operation. This thesis provides an investigation into upper limb movement after surgery in terms of gross motor control and ipsilateral descending motor pathways for distal function. A neurophysiological assessment was used to identify the pathway driving the distal muscles of the paretic upper limbs. The results support the findings of previous studies that suggest superior function is likely to be dependent on a common, branching corticospinal pathway to the left and right sides. In addition, one patient without evidence of a common pathway had some use of the paretic wrist suggesting the presence of a distinct ipsilesional – possibly corticoreticulospinal – pathway. Upper limb kinematics during functional unimanual and bimanual reaching was also assessed. Unimanual deficits were identified and abnormalities in inter-limb coordination were found. These include a tendency to perform bimanual reaches as sequential unimanual reaches and reduced spatial interference in the trajectories of the two limbs. Whilst there were significant differences between the comparison and patient groups for these measures, there was also significant variance between the patients, underlining the heterogeneity of this cohort.

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