68 CHAPTER 4 parieto-occipital network that includes key motor regions such as premotor cortex and supplementary motor area, as well as areas in the posterior parietal cortex along the dorsal visual stream24, 30, 40, 58, 59, 70, 123 The hand laterality judgment task has been shown to be sensitive to altered cerebral processes in other asymmetric central and peripheral neurological disorders of the upper limb, as evidenced by behavioural deficits found in focal hand dystonia, 31 carpal tunnel syndrome, 45 traumatic brachial plexus injury, 98 and during brachial plexus anaesthesia. 73 Interestingly, fMRI studies in Parkinson’s disease have shown that the hand laterality judgment task can detect cerebral changes across the whole fronto-parietal-occipital network, including occipito-parietal regions outside the pathological substrate of this central nervous system disorder. 40, 59 Accordingly, here we use fMRI during performance of the hand laterality judgment task to characterize somatomotor and/or visuomotor cerebral alterations in neuralgic amyotrophy. We additionally explore the relation between these potential cerebral alterations and clinical symptoms. Materials and Methods This is a sub-study of a randomized controlled trial (RCT), which investigates the effect of specialized rehabilitation on residual complaints in NA, in addition to the role that cerebral mechanisms may play in patients’ persistent motor problems. All MRI-compatible individuals participating in the RCT were included in the current sub-study. We used the fMRI and relevant clinical data collected during the pre-treatment baseline assessment to compare to healthy participants. For an extensive description of the RCT see Lustenhouwer et al. 124 The study was approved by the local medical ethical committee (Medical Ethical Committee region Arnhem-Nijmegen, CMO 2017-3740) and is registered at ClinicalTrials. gov (NCT03441347). Participants Forty-seven patients with a right-sided NA of the brachial plexus were included as part of the RCT (see Table 1 for details). Due to the COVID-19 pandemic and subsequent national measures, inclusion was terminated short of the original goal of 50 patients. Twenty-five age- and sex-matched healthy participants additionally participated. All participants were ≥ 18 years of age and had right hand dominance (as evidenced by a score of > +40 on the Edinburgh Handedness Inventory46). NA patients who presented with clearly lateralized symptoms of the right upper extremity, exhibited explicit coordinative motor dysfunction (i.e. scapular dyskinesia), who were no longer in the acute inflammatory phase (i.e. >8 weeks after attack onset), had not yet received specialized rehabilitation care and had no relevant comorbidities, were recruited through the Neuromuscular Center of the Radboud university medical center. Healthy participants without current or previous shoulder problems and other relevant comorbidities (e.g. neurological or muscular disorders) were recruited through the university’s subject database. See Lustenhouwer et al. 124 for a detailed description of the recruitment procedures and in- and exclusion criteria. Data from 39 NA patients and 23 healthy participants were analysed. We excluded three patients because of contraindications for MRI, two patients had bilateral NA, one patient and one healthy participant had a pre-existing condition missed at initial
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