Neuropsychologia 46 (2008) 886–901
Ipsilesional and contralesional sensorimotor function after
hemispherectomy: Differences between distal and proximal function
, F. Vargha-Khadem
, C.E. Polkey
, L. Weiskrantz
Experimental Psychology, Helmholtz Instituut, Utrecht University, Heidelbergbaan 2, 3584 CS Utrecht, The Netherlands
Developmental Cognitive Neuroscience Unit, University College London, Institute of Child Health, and Great Ormond
Street Hospital for Children NHS Trust, United Kingdom
The Department of Academic Clinical Neurosciences, King’s College School of Medicine and Dentistry,
King’s College Hospital, London, United Kingdom
Department of Experimental Psychology, University of Oxford, United Kingdom
Received 15 August 2007; received in revised form 7 November 2007; accepted 29 November 2007
Available online 3 December 2007
Previous studies have reported mainly on contralesional somatosensory and motor function after hemispherectomy. So far, ipsilesional impair-
ments have received little attention even though these have been reported in patients with less extensive lesions. In the current study we assessed
ipsilesional and contralesional sensorimotor function in a group of 12 patients with hemispherectomy. In addition, we focused on differences
between distal and proximal function and investigated several factors that may have contributed to individual differences between patients. The
tests included tapping, force production, tactile double simultaneous stimulation, pressure sensitivity, passive joint movement sense and sensitivity
to hot and cold.
Ipsilesional impairments were found on all tests, except passive joint movement sense. Unexpectedly, no signiﬁcant ipsilateral distal–proximal
gradient was found for any of the measures. Both the removal of the diseased cerebral hemisphere and possible changes to the remaining brain
structures may have affected ipsilesional sensorimotor function.
Contralesional performance was impaired on all tests except for passive joint movement in the shoulder. The contralesional impairments were
characterized by a distal–proximal gradient measured on all tests, except that of sensitivity to hot and cold. Distal function was always most
impaired. The difference between distal and proximal motor function is in agreement with the established concepts of the motor pathways, with
the motoneurons innervating proximal muscles receiving bilateral cortical and subcortical input.
Age at onset of original brain damage correlated signiﬁcantly with passive joint movement sense. Patients with known abnormalities to the
remaining brain structures performed inferior on the tapping test only. No effect was found of the hemispheric side of removal.
© 2007 Elsevier Ltd. All rights reserved.
Keywords: Hemispherectomy; Motor; Somatosensory; Ipsilateral
Hemispherectomy is a surgical procedure by which the cortex
of one cerebral hemisphere is removed (Dimond, 1972) or func-
tionally disconnected (De Almeida, Marino, Aguiar, & Jacobsen
Teixeira, 2006). Although it was ﬁrst performed for treatment
of malignant glioma’s in adults (Dandy, 1928), the operation
is currently carried out mainly for relief of severe intractable
E-mail address: firstname.lastname@example.org (H.C. Dijkerman).
epilepsy in patients who have sustained unilateral brain damage
Somatosensory and motor function after hemispherectomy
has been evaluated in many studies. Several of the earlier
reports, however, described the effect of the operation on var-
ious functions (vision, intelligence, language, etc.) including
somatosensory and motor performance (among others Ameli,
1980; Beardsworth & Adams, 1988; Bell & Karnosh, 1949;
Cairns & Davidson, 1951; Damasio, Lima, & Damasio, 1975;
Gardner, 1933; Gardner, Karnosh, McClure, & Gardner, 1955;
Krynauw, 1950; Obrador, 1964; Verity et al., 1982; Wilson,
1970), but with an emphasis usually on clinical descriptions
0028-3932/$ – see front matter © 2007 Elsevier Ltd. All rights reserved.