Findings/Discussion

Each subject’s three fMRI images were chosen for analyzing. The ratio of the area in fMRI to total area of related hemisphere was calculated. The data are summarized in Table 2.

In Figure 1 and Figure 2 the activity areas of subject number 7’s and number 9’s fMR examinations are shown respectively.

Fig. 1a

Fig. 1b

Figure 1
The activity areas of subject number 7’s fMRI who is in Group I. A. During the right lower extremity movements there were no activation in primer motor cortex and sensorial cortex but there were activation in premotor cortex and suplemantary motor cortex (Total area: %1.06, Right hemispheric area: %1.02, Right hemispheric motor area: %0.15, Left hemispheric area: %1.02, Left hemispheric motor area: %0.52). B. During the amputated left lower extremity movements there were no activation in primer motor cortex and premotor cortex but there were activation in suplemantary motor cortex.(Total area: %0.98, Right hemispheric area: %0.62, Right hemispheric motor area: %0, Left hemispheric area: %1.32, Left hemispheric motor area: %0).

Fig. 2a

Fig. 2b

Figure 2
The activity areas of subject number 9’s fMRI who is in Group II. A. During the right lower extremity movements activation in primer motor cortex and sensorial cortex was detected (Total area: %0.37, Right hemispheric area: %0.11, Right hemispheric motor area: %0, Left hemispheric area: %0.67, Left hemispheric motor area: %0.12). B. During the amputated left lower extremity movements there were no activation in primer motor cortex and premotor cortex but there were activation in suplemantery motor cortex (Total area: %2.13, Right hemispheric area: %2.28, Right hemispheric motor area: %0.67, Left hemispheric area: %1.98, Left hemispheric motor area: %0.72).

Table 2. The ratio of each extremity movement’s activation area to total area of related hemisphere. (TBAA: Total brain activation area, TBA: Total brain area, CHAA: opposite hemispheric activation area, CHA: opposite hemispheric area, RHAA: Related hemispheric activation area, RHA: Related hemispheric area, CHMA: opposite hemispheric motor area, RHMA: Related hemispheric motor area)

Subject Number	Side	Amputated Extremity Group					Non-amputated Extremity Group
		TBAA/TBA (%)	CHAA/CHA (%)	RHAA/RHA (%)	CHM/CHA (%)	RHM/RHA (%)	TBAA/TBA (%)	CHAA/CHA (%)	RHAA/RHA (%)	CHM/CHA (%)	RHM/RHA (%)
1	Left	0	0	0	0	0	11.21	9.98	12.32	0.71	2.96
5	Left	0.79	1.10	0.25	0.57	0.13	3.47	2.91	3.95	0.50	1.26
6	Right	0	0	0	0	0	2.07	2.99	1.18	2.89	1.16
7	Left	0.98	0.62	1.32	0	0	1.06	1.09	1.02	0.52	0.15
8	Left	1.28	2.70	0.05	0.59	0	0.73	0.81	0.63	0.27	0
9	Left	2.15	2.28	1.98	0.67	0.72	0.37	0.67	0.11	0.12	0
10	Right	0.52	1.02	0.03	0.55	0.03	—	—	—	—	—
	Left	0.82	0.25	1.46	0.04	0.58	—	—	—	—	—
11	Right	0.36	0.57	0.17	0.16	0	—	—	—	—	—
	Left	0.13	0	0.27	0	0.05	—	—	—	—	—
12	Right	—	—	—	—	—	0.19	0.35	0.04	0.17	0.04
	Left	—	—	—	—	—	0.96	0.93	0.98	0.09	0.15
13	Right	—	—	—	—	—	1.53	1.47	1.59	0.28	0.10
	Left	—	—	—	—	—	1.06	1.38	0.76	0.22	0
14	Right	—	—	—	—	—	2.29	3.28	2.54	0.08	0.63
	Left	—	—	—	—	—	0.43	0.77	0.11	0.15	0
15	Right	—	—	—	—	—	0.67	1.37	0.22	1.06	0
	Left	—	—	—	—	—	3.08	3.52	2.41	2.05	0.40
16	Right	—	—	—	—	—	5.40	6.54	4.23	0.55	0.44
	Left	—	—	—	—	—	6.98	7.01	6.96	1.40	0.89

These data were evaluated statistically. Subject number 2 was excluded due to cooperation failure during the MRI examination. Subject number 3 and subject number 4 were excluded because no significant activation was detected in their fMRI examinations.

We found that fMRI results of diabetic patients had decreased cortical activation when compared with the healthy subject (p<0.05) as a result of decreased brain afferentiation (38).

According to our analysis fMRI results of amputated lower limbs during movement had decreased cortical activation when compared with non-amputated lower limbs (p<0.05) as a result of cerebral cortical reorganization.

In our study, no statistically significant relations between fMRG results and the amputation periods, patients’ ages or the DM diagnosis intervals were observed. However, the data of extremities of the non amputaded diabetic patients shows that, the decrease in the total contrlateral hemispheric activation area is associated with the increased patient age and it was found to be statistically significant according to the regression analysis (p<0.05). Although no significant relation between amputated patients’ ages and fMRG results were found, the decrease in cortical activation values (P<0.05) with the increase in the age of the non-amputated group can be correlated with the decrease in the cortical neuronal activation in the chronically gained afferentiation period.

We have determined that a plasticity changes in diabetic patients’ central nervous system which is a consequence of chronically decreased afferentiation is due to decreased or lost sensorial conduction.