Corticospinal volleys evoked by electrical stimulation of human motor cortex after withdrawal of volatile anaesthetics

Variability of motor-evoked potentials recorded during nitrous oxide anesthesia from the tibialis anterior muscle after transcranial electrical stimulation

When recorded as a compound muscle action potential (CMAP), the motor-evoked potential (MEP) is affected by volatile anesthetics and nitrous oxide. However, MEPs recorded using epidural electrodes in the presence of nitrous oxide are highly reproducible from trial to trial. We wished to establish the reproducibility over time of the CMAP produced by supramaximal transcranial electrical stimulation of the human motor cortex. Cascades of 100 successive CMAPs were recorded from the tibialis anterior muscles of six anesthetized patients undergoing scoliosis surgery, in response to transcranial electrical stimuli of > 500 V. Satisfactory CMAPs could be recorded in the presence of nitrous oxide, but not isoflurane. Latencies and amplitudes were reproducible in repeated sequences of 100 responses. However, amplitude and, to a lesser extent, latency, were highly variable within a sequence. In addition, occasional individual stimuli, although rarely successive ones, failed to evoke a CMAP. CMAPs have a much higher trial-to-trial variability than corticospinal volleys recorded from the epidural space. Using the present methodology it would be difficult to rely on CMAP recordings as an indicator of corticospinal function in the clinical monitoring situation.

Selective facilitation of responses to cortical stimulation of proximal and distal arm muscles by precision tasks in man

1. The responses of the first dorsal interosseus (1DI), opponens pollicis (OP), extensor digitorum communis (EDC), brachioradialis (BR), biceps brachii (BB) and anterior deltoid (AD) muscles to magnetic stimulation of the motor cortex were recorded during different motor tasks. 2. Two precision and two power isometric tasks were investigated. The precision tasks were a pincer grip ('grip') and a thrust against a target with the wrist ('push'). In the former, the prime movers were the intrinsic hand muscles, while the proximal muscles played a postural role. In the latter, the prime movers were the proximal muscles. In both tasks, force was controlled through visual feedback. The power tasks required encirclement of a cylinder with the fingers ('grasp'), or sustaining a weight suspended at wrist level ('load'). 3. Magnetic stimulation was applied in eight subjects by a coil placed over the vertex at 1.1-1.2 times the motor threshold for the most excitable muscles. This produced in the prime mover muscles larger motor-evoked responses (MEPs) during grip or push tasks than grasp or load tasks, in spite of similar background EMG levels. During grip tasks, only one of the two prime movers showed task-dependent changes. In the postural muscle AD there was no significant difference between MEPs during grip and grasp tasks; however, BB responses were larger during grasp than grip tasks. 4. MEPs simultaneously recorded in the prime movers were plotted against each other. The slope of the regression line for AD versus BB was larger in push than load tasks, whilst the changes in MEPs of 1DI and OP were independent during both grip and grasp tasks. 5. In three subjects, MEPs were also elicited by electrical stimulation during grip and grasp tasks. MEP changes tended to parallel those obtained for magnetic stimulation, but the increase in size of the electrically evoked MEPs during the precision task was smaller. 6. In all subjects the median and ulnar nerves were stimulated during grip and grasp tasks, and an H reflex was evoked in the hand muscles of five subjects. In no case did the two tasks produce reflexes of different amplitude. 7. The motor response of both proximal and distal muscles can be task dependent, in spite of the differences in their principal functional role and cortical representation. The modulation is related to the degree of control requested by the task, and is likely to reflect selective changes in the excitability of corticospinal neurones.

Motor effects of stimulating the human cerebellar thalamus

1. Observations were made on seven human subjects with electrodes implanted in the cerebellar thalamus for the control of tremor. 2. Weak stimulation at 1-2 Hz resulted in sudden lapses of posture of actively contracting contralateral limb muscles. Stronger stimuli caused muscle twitches even in relaxed muscles. 3. The stronger stimuli produced short latency facilitation of EMG activity in contralateral muscles; the pattern of muscle facilitation, the conduction velocity of the descending pathway and the estimated rise time of the underlying composite EPSP were consistent with direct activation of the corticospinal tract. 4. The lapses of posture produced by the weaker stimuli were associated with inhibition of ongoing EMG for up to 150 ms. This was due to the interruption of tonic drive to motoneurons rather than to their inhibition and was associated with depression of the motor evoked potential in relaxed muscles produced by weak anodal transcranial stimulation. The inhibition could be produced by 0.1 ms pulses, implying that a large-diameter fibre system was being activated. 5. A number of mechanisms could contribute to the inhibition, including inhibition from the reticular nucleus of the thalamus.

Rapid on-line estimation of responses to transcranial magnetic and peripheral nerve electrical stimulation in single human motoneurons

Cross-correlation experiments allow to obtain information about synaptic potentials in human motoneurons. However, recording cross-correlation responses of one motoneuron to transcranial magnetic and electrical peripheral nerve stimulation requires a considerable recording time when both responses are recorded consecutively. In this paper a method is introduced yielding the same information about the responses of a single motoneuron to both types of stimuli while requiring only a fraction of the recording time necessary for a conventional cross-correlation experiment. The main features of the method introduced were: (i) use of the recharging time of the magnetic stimulator for response recording to the electrical stimulus, (ii) use of specific stimulus timing with respect to the motor unit discharges, and (iii) on-line display with statistical testing of the response functions allowing to stop stimulus application, if the responses to both types of stimuli had reached statistical significance. Application of the method is demonstrated with response recording of 70 tibialis anterior motor units from five healthy volunteers to transcranial magnetic and peroneal nerve electrical stimulation.

The excitability of human corticospinal neurons is depressed by thiopental

BACKGROUND

We tested the effect of thiopental on the excitability of the corticospinal-motoneuron axis in normal human subjects.

METHODS

Magnetic stimulation was used to excite the neurons in the motor cortex which give rise to the fast conducting corticospinal pathway. The characteristics of the composite excitatory post-synaptic potentials (EPSPs) produced in individual spinal motoneurons by cortical stimulation were derived from changes in the firing probability of voluntarily activated motor units of the first dorsal interosseous muscle.

RESULTS

In 5 normal subjects, we found that thiopental, in incremental doses sufficient to sustain drowsiness (total dose 75 to 175 mg), significantly reduced the amplitude of these composite EPSPs.

CONCLUSIONS

Thiopental reduced the facilitation of motoneurons from the cortex most likely by depressing cortical neurons.

Response of arm flexor muscles to magnetic and electrical brain stimulation during shortening and lengthening tasks in man

1. The responses of the brachioradialis and biceps brachii muscles to non-invasive magnetic and electrical stimulation of the human motor cortex have been investigated during performance of different tasks. 2. Both muscles were simultaneously active during elbow flexor isometric torque, or forearm flexion lifting a weight (shortening contraction), or extension breaking the fall of the weight (lengthening contraction). The forearm extensor triceps brachii muscle was not engaged in any task. By using different weights, comparable levels of EMG activity were obtained in the same muscle across tasks. 3. Both magnetic (7 subjects) and electrical (3 subjects) brain stimulation (at about 1.5 times the motor threshold) produced larger responses during shortening, and smaller responses during lengthening, in the brachioradialis muscle with respect to isometric contractions, in spite of equal background EMG levels. Responses evoked in the biceps brachii by either stimulation mode were smaller during lengthening but not significantly enhanced during shortening. No consistent differences in the task-related modulation of the responses were present between electrical or magnetic stimulations. No significant changes in the evoked responses occurred during passive elbow flexion or extension. 4. In three subjects, the H reflex was evoked in the brachioradialis by stimulation of the radial nerve during performance of the same tasks. The pattern of task-related modulation of the reflex amplitude paralleled that obtained for brain stimulation. 5. The opposite modulation induced by the shortening and lengthening tasks both in magnetically and electrically evoked motor responses, and in the H reflex, suggests that task-related changes in excitability of the cortical neurones play a minor role.(ABSTRACT TRUNCATED AT 250 WORDS)

Increase of sympathetic discharge to skeletal muscle but not to skin during mild lower body negative pressure in humans

1. Haemodynamic studies in humans have concluded that the cutaneous circulation is regulated by cardiopulmonary baroreceptors. In contrast, neurophysiological studies have indicated that skin sympathetic outflow, unlike muscle sympathetic outflow, is unaffected by perturbations in baroreceptor activity. 2. Thus, in an attempt to resolve this discrepancy, both muscle and skin sympathetic nerve activity was recorded during unloading of mainly cardiopulmonary afferents with non-hypotensive lower body negative pressure (LBNP) performed in both normothermic and hyperthermic conditions. The function of the sympathetic activity was studied by estimations of skin blood flow (laser Doppler velocimetry), of calf blood flow (plethysmography) and of sudomotor activity (electrodermal responses). 3. A level of LBNP that caused robust increases in sympathetic outflow and vascular resistance in the skeletal muscle of the lower leg had no effect on sympathetic activity and vascular resistance in the skin of the same region in the same subjects. Both at normothermia and during hyperthermia LBNP decreased electrodermal activity. Experiments performed during sham LBNP and with skin temperature kept constant suggest that the electrodermal response was due to a decrease in skin temperature produced by the LBNP. 4. In conclusion, these findings challenge the concept that the cutaneous circulation participates importantly in the peripheral circulatory adjustments to unloading of cardiopulmonary afferents during orthostatic stress in humans. During non-hypotensive LBNP, the skeletal muscle bed accounts for all of the reflex vasoconstriction in the calf.

Transcranial electrical stimulation of the motor cortex in man: further evidence for the site of activation

1. The motor cortex was stimulated electrically (vertex anode; cathode 6 cm lateral) in neurologically normal subjects undergoing surgery for scoliosis, and the evoked corticospinal volleys were recorded from the spinal cord using epidural electrodes. 2. Stimuli > 330 V produced a complex D-wave volley containing three separate peaks, with high-threshold components, 0.8 ms (D2) and 1.6 ms (D3), in advance of the lowest-threshold component (D1). As stimuli increased up to 1500 V, D3 replaced the later components completely, but there was no further latency 'jump'. 3. Brainstem stimulation using electrodes over each mastoid process produced a descending volley that had the same latencies as D3. At threshold, stimulation of the brainstem or spinal cord attenuated the D wave evoked by simultaneous cortical stimulation. 4. It is concluded that transcranial electrical stimulation of the motor cortex at high intensities can access corticospinal neurones at the pyramidal decussation, and that stimulation of the brainstem (and the spinal cord) preferentially accesses corticospinal axons. At threshold, motor cortex stimulation probably activates corticospinal neurones at or near the cerebral cortex.

Suppression of voluntary motor activity revealed using transcranial magnetic stimulation of the motor cortex in man

1. Suppression of voluntary muscle activity of hand and arm muscles in response to transcranial magnetic stimulation (TMS) of the motor cortex has been investigated in man. 2. Suppression could be elicited by low levels of TMS without any prior excitatory response. The latency of the suppression was 3-8 ms longer than the excitation observed at a higher stimulus intensity. The duration of the suppression ranged from 8 to 26 ms. 3. A circular stimulating coil was used to determine threshold intensity for excitation and suppression of contraction of thenar muscles in response to TMS at different locations over the motor cortex. The locations for lowest threshold excitation coincided with those for lowest threshold suppression. Suppression was elicited at a lower threshold than excitation at all locations. 4. A figure-of-eight stimulating coil was positioned over the left motor cortex at the lowest threshold point for excitation of the right thenar muscles. The orientation for the lowest threshold excitatory and inhibitory responses was the same for all subjects. That orientation induced a stimulating current travelling in an antero-medial direction. Suppression was invariably elicited at lower thresholds than excitation. 5. When antagonistic muscles (second and third dorsal interosseus) were co-contracted, TMS evoked coincident suppression of voluntary EMG in the two muscles without prior excitation of either muscle. This suggests that the suppression is not mediated via corticospinal activation of spinal interneurones. 6. Test responses to electrical stimulation of the cervical spinal cord were evoked in both relaxed and activated thenar muscles. In the relaxed muscle, prior TMS at an intensity that would suppress voluntary activity failed to influence the test responses, suggesting absence of inhibition at a spinal level. However, in the activated muscle, prior TMS could reduce the test response. This may be explained by disfacilitation of motoneurones due to inhibition of corticospinal output. 7. We propose that suppression of voluntary muscle activity by TMS is due in large part to activation of a mechanism within the motor cortex that reduces the corticospinal output to the muscle. It is concluded that TMS evokes excitation and inhibition via neuronal structures lying close to one another and having similar orientations.

Effect of tonic voluntary activity on the excitability of human motor cortex

1. The threshold for obtaining EMG responses after transcranial magnetic stimulation of the brain is reduced by voluntary contraction of the target muscle. The present experiments tested whether some of this effect is due to increased cortical, as opposed to spinal, excitability during the contraction. 2. Magnetic stimulation was delivered with a figure-of-eight coil oriented with the junction region along the interaural line and also (in 4 of 7 subjects) with a circular coil centred at the vertex. The intensity of the conditioning stimulus was subthreshold for evoking a motor response in the relaxed wrist flexor muscles of the forearm. The presence of a small descending corticospinal volley in both the relaxed and active conditions was detected by measuring the facilitation of test H reflexes elicited in the flexor muscles of the forearm. 3. In all subjects, magnetic stimulation with either coil facilitated the H reflex at conditioning-test intervals of -1 to -3 ms (median nerve stimulus before magnetic). This was followed by a long-lasting facilitation. In three of the seven subjects stimulation with the figure-of-eight coil elicited an additional, earlier peak of facilitation at a conditioning-test interval of -3 to -5 ms. 4. In all subjects, the threshold for obtaining facilitation of the H reflex using a conditioning-test interval of -1 to -3 ms was reduced, and the amount of facilitation was larger, if subjects performed a weak tonic voluntary contraction. In contrast, with a conditioning-test interval of -3 to -5 ms voluntary contraction had no effect on the threshold. 5. It is suggested that H reflex facilitation at the conditioning-test interval of -1 to -3 ms was produced by indirect activation of corticospinal neurones by the magnetic stimulus, whereas at -3 to -5 ms, the facilitation was produced by direct activation of corticospinal axons. It is concluded that tonic voluntary contraction of a target muscle decreases the threshold for indirect activation of corticospinal neurones but not for direct stimulation of their axons.

Quantification of D- and I-wave effects evoked by transcranial magnetic brain stimulation on the tibialis anterior motoneuron pool in man

Transcranial stimulation in man evokes multiple descending volleys in the spinal cord giving rise to multiple subpeaks in a peri-stimulus-time histogram (PSTH) obtained from a cross-correlation of motor unit discharges with transcranial stimuli. The first volley is termed the D wave, as it is assumed to be evoked by direct excitation of pyramidal tract neurons, whereas the subsequent I waves appear to be generated by indirect excitation of the pyramidal tract neurons via cortical interneurons. It was the aim of this study to obtain an estimate of the effect induced by multiple volleys evoked by transcranial magnetic stimulation on the entire motoneuron pool of the tibialis anterior in awake subjects. A considerable part of a particular motoneuron pool was investigated by sampling responses of a large number (at least 19) from each muscle investigated. In total, three tibialis anterior muscles from three normal volunteers were studied. From each of the 63 units included in this study, a PSTH to 100 transcranial magnetic stimuli and a PSTH to 100 electrical stimuli given to the peroneal nerve were compiled. From the motor unit response to the peripheral nerve stimulation, the latency of the single-unit H reflex peak was obtained. This yielded, the timing of the subpeaks in response to the magnetic stimulation relative to the timing of the H reflex of the same unit, thus eliminating the influence of the peripheral conduction time from the motoneuron to the recording electrode. It was found that 50 (79%) of the motor units exhibited at least two subpeaks in response to the cortical stimulus.(ABSTRACT TRUNCATED AT 250 WORDS)

Corticocortical inhibition in human motor cortex

1. In ten normal volunteers, a transcranial magnetic or electric stimulus that was subthreshold for evoking an EMG response in relaxed muscles was used to condition responses evoked by a later, suprathreshold magnetic or electric test shock. In most experiments the test stimulus was given to the lateral part of the motor strip in order to evoke EMG responses in the first dorsal interosseous muscle (FDI). 2. A magnetic conditioning stimulus over the hand area of cortex could suppress responses produced in the relaxed FDI by a suprathreshold magnetic test stimulus at interstimulus intervals of 1-6 ms. At interstimulus intervals of 10 and 15 ms, the test response was facilitated. 3. Using a focal magnetic stimulus we explored the effects of moving the conditioning stimulus to different scalp locations while maintaining the magnetic test coil at one site. If the conditioning coil was moved anterior or posterior to the motor strip there was less suppression of test responses in the FDI. In contrast, stimulation at the vertex could suppress FDI responses by an amount comparable to that seen with stimulation over the hand area. With the positions of the two coils reversed, conditioning stimuli over the hand area suppressed responses evoked in leg muscles by vertex test shocks. 4. The intensity of both conditioning and test shocks influenced the amount of suppression. Small test responses were more readily suppressed than large responses. The best suppression was seen with small conditioning stimuli (0.7-0.9 times motor threshold in relaxed muscle); increasing the intensity to motor threshold or above resulted in less suppression or even facilitation. 5. Two experiments suggested that the suppression was produced by an action on cortical, rather than spinal excitability. First, a magnetic conditioning stimulus over the hand area failed to produce any suppression of responses evoked in active hand muscles by a small (approximately 200 V, 50 microsecond time constant) anodal electric test shock. Second, a vertex conditioning shock had no effect on forearm flexor H reflexes even though responses in the same muscles produced by magnetic cortical test shocks were readily suppressed at appropriate interstimulus intervals. 6. Small anodal electric conditioning stimuli were much less effective in suppressing magnetic test responses than either magnetic or cathodal electric conditioning shocks.(ABSTRACT TRUNCATED AT 400 WORDS)

Direct comparison of corticospinal volleys in human subjects to transcranial magnetic and electrical stimulation

1. The effects of graded transcranial magnetic and anodal electrical stimulation of the human motor cortex were compared in human subjects undergoing orthopaedic operations on the spine, before and after withdrawal of volatile anaesthesia. Corticospinal volleys were recorded from the spinal cord in the low-cervical and low-thoracic regions (six subjects) or the mid-thoracic region (two subjects) using bipolar electrodes inserted into the epidural space. 2. Electrical stimuli were delivered using anode at the vertex and cathode 7 cm laterally. The corticospinal volley at threshold consisted of a single deflection with a mean latency to peak of 4.17 ms at the rostral recording site. With further increases in stimulus strength the latency of this D wave shortened in two steps, first by 0.89 ms (seven subjects) and then by a further 0.8 ms (two subjects), indicating that the site of activation of some corticospinal neurones had shifted to deep subcortical sites. 3. When volatile anaesthetics were given, a corticospinal volley could not be defined in three subjects with magnetic stimuli of 70, 80 and 100% maximal stimulator output with the coil at the vertex (Novametrix Magstim 200, round coil, external diameter 14 cm). In the remaining five subjects, the component of lowest threshold was a D wave recorded at the rostral site at 4.0 ms when stimulus intensity was, on average, 70%. With stimuli of 90-100% a total of five small I waves could be defined in the five subjects (i.e. on average one I wave per subject). 4. After cessation of volatile anaesthetics in seven subjects, the thresholds for D and I waves were lower and their amplitudes were greater. The D wave remained the component of lowest threshold in all subjects, appearing at the low-cervical level with magnetic stimuli of 50%. However, in three subjects I waves also appeared at D wave threshold, and the D wave was smaller than with electrical stimulation at I wave threshold. There was no consistent change in latency of the magnetic D wave as stimulus intensity was increased to 100%. 5. These findings suggest that the previously reported difference in latency of the EMG potentials produced in upper-limb muscles by anodal stimulation and magnetic stimulation of the human motor cortex is not because the corticospinal volley induced by magnetic stimulation lacks a D wave.(ABSTRACT TRUNCATED AT 400 WORDS)

Task dependence of responses in first dorsal interosseous muscle to magnetic brain stimulation in man

1. The response of the first dorsal interosseous (1DI) muscle to non-invasive magnetic and scalp electrical stimulation of the brain have been investigated during performance of different manual tasks. 2. The six tasks tested required activation of the 1DI muscle, either in isolation (during abduction of the index finger) or as part of a more complex pattern of muscle synergies (e.g. during power grip). The level of 1DI EMG activity across tasks was kept constant by providing subjects with visual feedback of their muscle activity. 3. In every subject (n = 14) magnetic stimulation produced larger responses during performance of complex tasks than during the simple index abduction task. The pooled results from all subjects showed that four of the five complex tasks were associated with significantly larger 1DI responses (paired t test, P < 0.05). 4. These results were confirmed at the single motor unit level for nine motor units recorded from six subjects. Subjects were requested to produce a steady discharge of the same motor unit during performance of different tasks. The probability of motor unit discharge in response to magnetic stimulation was significantly greater during complex tasks (rotation or pincer grips) than during abduction. 5. Scalp electrical stimulation was performed in three subjects with the cathode at the vertex and the anode over the contralateral motor cortex. The pattern of response amplitudes in the different tasks tended to parallel that obtained for magnetic stimulation, but the task-related differences were smaller. 6. These results suggest that during performance of the different tasks, the corticospinal volleys evoked by magnetic stimulation may vary in amplitude. The task-related cortical mechanisms that may contribute to this variability are discussed.

Assessment of corticospinal and somatosensory conduction simultaneously during scoliosis surgery

The function of descending motor pathways and that of ascending sensory pathways in the spinal cord were monitored at the same time in 120 patients undergoing surgery for scoliosis. Transcranial electrical stimulation of the motor cortex was performed simultaneously with stimulation of the tibial nerves in the popliteal fossae, and the descending and ascending volleys were recorded from the spinal cord at two levels using epidural electrodes. Stable recordings of both volleys have been obtained in all neurologically normal patients and in many with pre-existing neurological deficits. The experimental conditions which resulted in reliable recordings were explored in select patients and include: a vertex-anode/lateral cathode montage for transcranial stimulation, epidural recording of evoked corticospinal and somatosensory volleys at two spinal levels, a high-pass filter of 500 Hz, and stable anaesthesia. The epidural recording allows full muscle relaxation and the use of volatile anaesthetics; recording at two levels allows a deterioration in function to be identified quickly and distinguished from an artifactual change.