Central motor reorganization was studied in 33 subjects with hemiplegi
c cerebral palsy. Corticospinal projections were investigated using fo
cal magnetic stimulation of the motor cortex. Reflex pathways were exa
mined with digital nerve stimulation. Cross-correlation analysis of mu
lti-unit EMG was used to detect activity in branched common stem last
order presynaptic inputs to motor neuron pools. The neurophysiological
findings were related to the clinical outcome. In 21 of the subjects
studied (64%), there was evidence for reorganization of central motor
pathways. The clinical and neurophysiological findings revealed two di
fferent forms of reorganization. In both forms focal magnetic stimulat
ion demonstrated novel ipsilateral motor pathways from the undamaged m
otor cortex to the hemiplegic hand. Ipsilateral projections were not d
emonstrated from the damaged motor cortex. Eleven subjects had intense
minor movements. In these subjects cross-correlation analysis and ref
lex testing suggested that corticospinal axons had branched abnormally
and projected bilaterally to homologous motor neuron pools on both si
des of the spinal cord. The remaining 10 subjects did not have intense
mirror movements and in these subjects there was no evidence for last
order branching of corticospinal axons. It was found that good functi
on of the hemiplegic hand was associated with the presence of EMG resp
onses in that hand following magnetic stimulation of the contralateral
motor cortex. When EMG responses were absent, hand function was poor
unless the subject had intense mirror movements.