Motor-unit responses in human wrist flexor and extensor muscles to transcranial cortical stimuli

On the function of muscle and reflex partitioning

Studies have shown that in the mammalian neuromuscular system stretch reflexes are localized within individual muscles. Neuromuscular compartmentalization, the partitioning of sensory output from muscles, and the partitioning of segmental pathways to motor nuclei have also been demonstrated. This evidence indicates that individual motor nuclei and the muscles they innervate are not homogeneous functional units. An analysis of the functional significance of reflex localization and partitioning suggests that segmental control mechanisms are based on subdivisions of motor nuclei–muscle complexes. A partitioned organization of segmental control mechanisms could utilize (1) the potential functional diversity of muscle fiber types, (2) the variety of mechanical actions of individual muscles arising from their distributed origins and insertions, and (3) diverse architectural features such as intramuscular variations in pinnation and complex in-series and in-parallel arrangements of muscle fibers. The differentiated activity observed in some muscles during natural movements also calls for localized segmental control mechanisms. Partitioning may also play a role in mechanical interactions between contracting motor units and in increasing the stability of neuromuscular systems. The functional advantages of reflex localization and partitioning suggest they are probably common features of segmental systems, whose organization reflects the structure and function of their associated neuromuscular systems.

Multiple Book Review of Speech perception by ear and eye: A paradigm for psychological inquiry

This book is about the processing of information in face-to-face communication when a speaker makes both audible and visible information available to a perceiver. Both auditory and visual sources of information are evaluated and integrated to achieve speech perception. The evaluation of the information source provides information about the strength of alternative interpretations, rather than just all-or-none categorical information, as claimed by “categorical perception” theory. Information sources are evaluated independently; the integration process insures that the least ambiguous sources have the most influences on the judgment. Similar processes occur in a variety of other behaviors, ranging from personality judgments and categorization to sentence interpretation and decision making. The experimental results are consistent with a fuzzy logical model of perception, positing three operations in perceptual (primary) recognition: feature evaluation, feature integration, and pattern classification. Continuously valued features are first evaluated, then integrated and matched against prototype descriptions in memory; finally, an identification decision is made on the basis of the relative goodness-of-match of the stimulus information with the relevant prototype descriptions.

Establishing the definition and inter-rater reliability of cortical silent period calculation in subjects with focal hand dystonia and healthy controls

The purpose of this paper is to describe a clearly defined manual method for calculating cortical silent period (CSP) length that can be employed successfully and reliably by raters after minimal training in subjects with focal hand dystonia (FHD) and healthy subjects. A secondary purpose was to explore intra-subject variability of the CSP in subjects with FHD vs. healthy subjects. Two raters previously naïve to CSP identification and one experienced rater independently analyzed 170 CSP measurements collected in 6 subjects with focal hand dystonia (FHD) and 9 healthy subjects. Intraclass correlation coefficient (ICC) was calculated to quantify inter-rater reliability within the two groups of subjects. The relative variability of CSP in each group was calculated by the coefficient of variation (CV). Relative variation between raters within repeated measures of individual subjects was also quantified by CV. Reliability measures were as follows-mean of three raters: all subjects: ICC=0.976; within healthy subjects: ICC=0.965; in subjects with FHD: ICC=0.956. The median within-subject variability for the healthy group was CV=7.33% and in subjects with FHD:CV=11.78%. The median variability of calculating individual subject CSP duration between raters was CV=10.23% in subjects with dystonia and CV=10.46% in healthy subjects. Manual calculation of CSP results in excellent reliability between raters of varied levels of experience. Healthy subjects display less variability in CSP. Despite greater variability, the CSP in impaired subjects can be reliably calculated across raters.

Automated-parameterization of the motor evoked potential and cortical silent period induced by transcranial magnetic stimulation

OBJECTIVE

To standardize the characterization of motor evoked potential (MEP) and cortical silent period (CSP) recordings elicited with transcranial magnetic stimulation (TMS).

METHODS

A computer-based, automated-parameterization program (APP) was developed and tested which provides a comprehensive set of electromyography (EMG) magnitude and temporal measures. The APP was tested using MEP, CSP, and isolated CSP (iCSP) TMS stimulus-response data from a healthy adult population (N=13).

RESULTS

The APP had the highest internal reliability (Cronbach's alpha=.98) for CSP offset time compared with two prominent automated methods. The immediate post-CSP EMG recovery level was 49% higher than the pre-TMS EMG level. MEP size (peak amplitude, mean amplitude, peak-to-peak amplitude, and area) correlated higher with effective E-field (E(eff)) than other intensity measures (r approximately 0.5 vs. r approximately 0.3) suggesting that E(eff) is better suited for standardizing MEP stimulus-response relationships.

CONCLUSIONS

The APP successfully characterized individual and mean epochs containing MEP, CSP, and iCSP responses. The APP provided common signal and temporal measures consistent with previous studies and novel additional parameters.

SIGNIFICANCE

With the use of the APP modeling method and the E(eff), a standard approach for the analysis and reporting of MEP-CSP complex and iCSP measurements is achievable.

Enhancement of single motor unit inhibitory responses to transcranial magnetic stimulation in amyotrophic lateral sclerosis

In healthy human subjects, transcranial magnetic stimulation (TMS) applied to the motor cortex induces concurrent inhibitory and excitatory effects on motoneurone activity. In amyotrophic lateral sclerosis (ALS), a neurodegenerative disease affecting both cortical and spinal motor neurons, paired-pulse studies based on electromyographic (EMG) recording have revealed a decrease in TMS-induced inhibition. This suggested that inhibition loss may promote excito-toxicity in this disease. Against this hypothesis, an abnormally high incidence of inhibitory responses to TMS has been observed in the peristimulus time histograms (PSTHs) in ALS single motor unit studies. The disappearance of cortico-motoneuronal excitatory inputs might, however, have facilitated the detection of single motor unit inhibitory responses in the PSTHs. This question was addressed here using a new approach, where the strength of the excitatory and inhibitory effects of TMS on motoneurone activity was assessed from the duration of inter-spike intervals (ISIs). This analysis was conducted on single motor unit (MU), tested on healthy subjects and patients with ALS or Kennedy's disease (KD), a motor neuron disease which unlike ALS, spares the cortico-spinal pathway. MUs tested on KD patients behaved like those of healthy subjects unlike those tested on ALS patients. The present data reveal that in ALS, the TMS-induced inhibitory effects are truly enhanced during voluntary contractions and not reduced, as observed in paired-pulse TMS studies under resting conditions. The possible contribution of inhibitory loss to the physiopathology of ALS therefore needs to be reconsidered. The present data do not support the idea that inhibition loss may underlie excito-toxicity in ALS.

An integrative transcranial magnetic stimulation mapping technique using non-linear curve fitting

The aim of this study is to develop a new simple method for analyzing one-dimensional transcranial magnetic stimulation (TMS) mapping studies in humans. Motor evoked potentials (MEP) were recorded from the abductor pollicis brevis (APB) muscle during stimulation at nine different positions on the scalp along a line passing through the APB hot spot and the vertex. Non-linear curve fitting according to the Levenberg-Marquardt algorithm was performed on the averaged amplitude values obtained at all points to find the best-fitting symmetrical and asymmetrical peak functions. Several peak functions could be fitted to the experimental data. Across all subjects, a symmetric, bell-shaped curve, the complementary error function (erfc) gave the best results. This function is characterized by three parameters giving its amplitude, position, and width. None of the mathematical functions tested with less or more than three parameters fitted better. The amplitude and position parameters of the erfc were highly correlated with the amplitude at the hot spot and with the location of the center of gravity of the TMS curve. In conclusion, non-linear curve fitting is an accurate method for the mathematical characterization of one-dimensional TMS curves. This is the first method that provides information on amplitude, position and width simultaneously.

Assessing the temporal reproducibility of human esophageal motor-evoked potentials to transcranial magnetic stimulation

BACKGROUND

Although the electrophysiological properties and reproducibility of somatic limb motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) are well characterized, little is known about the reproducibility of MEPs for viscerosomatic structures such as the esophagus.

AIM

To determine the temporal reproducibility of esophageal MEPs to TMS.

METHODS

MEPs to TMS were recorded from the proximal esophagus, using a swallowed catheter housing a pair of electrodes, in eight healthy subjects at five stimulus intensities (SI) (motor threshold [MT] to 20% above MT). For each SI, 20 consecutive TMS stimuli at 5-second intervals were delivered over a single scalp site (dominant hemisphere at site exhibiting MT at lowest SI) and repeated 40 and 80 minutes thereafter. MEP amplitudes and latencies were measured, and means were sequentially calculated for each SI and then log-transformed. The repeatability coefficients (RC) for the three time points were calculated across each set of 20 stimuli and presented as an exponential ratio.

RESULTS

Best RC (amplitude/latency) were achieved at 120% SI relative to MT, being 1.8/1.2 (optimal = 1.0). For lower intensities of 115%, 110%, 105%, and 100% SI, the RC were 2.1/1.2, 2.1/1.1, 2.4/1.2, and 2.6/1.4, respectively. For all SI, the greatest reductions in RC occurred over the first 10 stimuli, with little additional gain beyond this number.

CONCLUSIONS

Latencies of esophageal MEP to TMS across intensities are highly reproducible, whereas amplitudes are more stimulus intensity-dependent, being most reliable and reproducible at the highest stimulus strengths.

SIGNIFICANCE

Using careful parameters, TMS can be used reliably in future studies of viscerosomatic structures, although the size of the response variability needs to be taken into account when assessing changes in cortico-fugal activity.

Inspiratory resistances facilitate the diaphragm response to transcranial stimulation in humans

Background

Breathing in humans is dually controlled for metabolic (brainstem commands) and behavioral purposes (suprapontine commands) with reciprocal modulation through spinal integration. Whereas the ventilatory response to chemical stimuli arises from the brainstem, the compensation of mechanical loads in awake humans is thought to involve suprapontine mechanisms. The aim of this study was to test this hypothesis by examining the effects of inspiratory resistive loading on the response of the diaphragm to transcranial magnetic stimulation.

Results

Six healthy volunteers breathed room air without load (R0) and then against inspiratory resistances (5 and 20 cmH₂O/L/s, R5 and R20). Ventilatory variables were recorded. Transcranial magnetic stimulation (TMS) was performed during early inspiration (I) or late expiration (E), giving rise to motor evoked potentials (MEPs) in the diaphragm (Di) and abductor pollicis brevis (APB). Breathing frequency significantly decreased during R20 without any other change. Resistive breathing had no effect on the amplitude of Di MEPs, but shortened their latency (R20: -0.903 ms, p = 0.03) when TMS was superimposed on inspiration. There was no change in APB MEPs.

Conclusion

Inspiratory resistive breathing facilitates the diaphragm response to TMS while it does not increase the automatic drive to breathe. We interpret these findings as a neurophysiological substratum of the suprapontine nature of inspiratory load compensation in awake humans.

Cortical versus spinal dysfunction in amyotrophic lateral sclerosis

Little is known about the possible link between cortical and spinal motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). We correlated the characteristics of the responses to transcranial magnetic stimulation (TMS) with the electromechanical properties and firing pattern of single motor units (MUs) tested in nine ALS patients, three patients with Kennedy's disease, and 15 healthy subjects. In Kennedy's disease, 19 of 22 MUs were markedly enlarged with good electromechanical coupling and discharged with great variability. Their excitatory responses increased with MU size. In ALS, 17 of 34 MUs with excitatory responses behaved as in Kennedy's disease. By contrast, 28 MUs with nonsignificant responses showed poor electromechanical coupling and high firing rates, whereas 28 MUs with inhibitory responses showed moderate functional alterations. This result indicates that in ALS as in Kennedy's disease, sprouting of corticospinal axons may occur on surviving motoneurons. A clear relationship exists between the responsiveness of MUs to TMS and their functional state.

Chronic neural adaptation induced by long-term resistance training in humans

While it is known that resistance training causes changes in the central nervous system (CNS) in the initial stages of training, there have been few studies of cumulative or sustained neural adaptation to resistance training beyond the initial periods. To further investigate this we compared the electromyographic (EMG) response to transcranial magnetic stimulation (TMS) during voluntary contractions of ten subjects who have been training for more than 2 years, resistance-training (RT) group, and ten subjects that have never participated in resistance training (NT). The active motor threshold for biceps brachii was obtained during voluntary elbow flexion at 10% of maximal voluntary contraction (MVC). TMS was also delivered at 100% of the maximal stimulator output while the participants exerted forces ranging from 10 to 90% of MVC. Evoked force, motor-evoked potential (MEP) amplitude and latency from biceps brachii was recorded for each condition to explore changes in corticospinal excitability. The evoked force was significantly lower in the RT group in comparison with the NT group between 30 and 70% of MVC intensity (P<0.05). At 90% of MVC, nine subjects from the RT group showed an absence in the evoked force while this occurred in only five subjects from the NT group. The MEP amplitude and latency changed significantly (P<0.001) with increasing levels of contraction, without significant difference between groups. These results indicate that changes in the CNS are sustained in the log-term practices of resistance training and permit a higher voluntary activation at several intensities of the MVC.

Responses of the diaphragm to transcranial magnetic stimulation during wake and sleep in humans

The human ventilation depends on bulbospinal and corticospinal commands. This study assessed their interactions in five healthy volunteers (two men, age 25-35) through the description of diaphragm and abductor pollicis brevis (APB) motor potentials (DiMEPs, abpMEPs) evoked by transcranial magnetic stimulation (TMS) during relaxed expiration and tidal inspiration and during wake and sleep. NREM decreased corticospinal excitability and REM further did so, for both the diaphragm and the APB. During wake, inspiration shortened supine DiMEPs latencies (expiration 18.56+/-1.90ms; inspiration 17.37+/-1.48ms, P<0.001). This persisted during sleep in an augmented manner (expiration: 21.05+/-1.39ms; inspiration 18.69+/-1.17ms, P=0.002). Inspiration had no effect on apbMEPs during wake and sleep.

IN CONCLUSION

(1) the tidal bulbospinal input to phrenic motoneurones is sufficient to modulate the throughput of the corticospinal pathway to these neurones; (2) this modulation is best seen after the sleep related removal of corticospinal and/or afferent inputs.

How salient is the silent period? The role of the silent period in the prognosis of upper extremity motor recovery after severe stroke

Transcranial magnetic stimulation (TMS) has been successful in the prediction of motor recovery in acute stroke patients with initially severe paresis or paralysis of the upper extremity. Motor evoked potentials (MEP) appear to have a high specificity but a rather low sensitivity with regard to motor recovery. The silent period (SP) has been proposed as an additional factor to the MEP for predicting motor recovery that might optimize the sensitivity of TMS. The authors reviewed the literature and case series focusing on the additional value of the SP to the MEP for predicting poststroke hand motor recovery. Studies that have analyzed the SP for predicting poststroke motor recovery have rather inconsistent results and suffer from heterogeneity in technical methods, methodology, and patient characteristics. In most studies, prolonged SPs have been found immediately after stroke, whereas in the (sub)acute phase thereafter, different patterns of SP duration have been found. These differences are thought to be related to stroke localization, though contraction-induced reduction phenomena and recovery-related intracortical phenomena may also be responsible. Although the SP might be used to identify clinically silent or minor strokes, in acute stroke patients with initial severe paresis or paralysis, the SP seems to have no additional value to MEP for predicting poststroke motor recovery. Nevertheless, the SP (poststroke-reduced SPs and contraction-induced inhibitory phenomena) has been proposed as a prognostic factor for poststroke spasticity. This review emphasizes the significance of the SP in predicting poststroke motor recovery and spasticity. Although the relation among the SP, recovery-related intracortical phenomena, and spasticity remains unclear, a neurophysiologic model underlying the SP is discussed. However, more research is needed on the value of the SP for predicting poststroke spasticity.

Rate-coding of spinal motoneurons with high-frequency magnetic stimulation of human motor cortex

Rate-coding in spinal motoneurons was studied using high-frequency magnetic stimulation of the human motor cortex. The subject made a weak contraction to cause rhythmic (i.e., tonic) discharge of a single motor unit in flexor (or extensor) carpi radialis or tibialis anterior, while the motor cortical representation of that muscle was stimulated with brief trains of pulses from a Pyramid stimulator (4 Magstim units connected by 3 BiStim modules). An "m@n" stimulus train consisted of m number of pulses (1–4), with an interpulse interval (IPI) of n ms (1–6). Peristimulus time histograms were constructed for each stimulus condition of a given motor unit, and related to the average rectified surface electromyography (EMG) from that muscle. Surface EMG responses showed markedly more facilitation than single-pulse stimulation, with increasing numbers of pulses in the train; responses also tended to increase in magnitude for the longer IPI values (4 and 6 ms) tested. Motor-unit response probability increased in a manner comparable to that of surface EMG. In particular, motoneurons frequently responded twice to a given stimulus train. In addition to recruitment of new motor units, the increased surface EMG responses were, in part, a direct consequence of short-term rate-coding within the tonically discharging motoneuron. Our results suggest that human corticomotoneurons are capable of reliably following high-frequency magnetic stimulation rates, and that this activity pattern is carried over to the spinal motoneuron, enabling it to discharge at extremely high rates for brief periods of time, a pattern known to be optimal for force generation at the onset of a muscle contraction.Key words: Human, single motor unit, repetitive transcranial magnetic stimulation, rate-coding, high-frequency stimulation, corticomotoneuron, peri-stimulus time histogram.

Long-latency motor evoked potentials in congenital hemiplegia

OBJECTIVE

To investigate long-latency motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation in congenital hemiplegia (CH) and to seek for correlation with paretic hand movement deficits.

METHODS

MEPs were recorded from the first dorsal interosseous of both hands in 12 CH patients and 12 age-matched controls; dexterity and upper limb function were quantitatively assessed in both groups.

RESULTS

In CH patients, long-latency MEPs, occurring much later than the commonly reported MEPs, were frequently observed in the paretic and non-paretic hands. Four distinct groups of long-latency MEPs were found, each cluster being identified by its mean latency, namely 35, 85, 160 and 225 ms. The residual dexterity of the paretic hand was correlated with the presence of contralateral MEPs with a 20 and 225 ms latency and was negatively correlated with ipsilateral MEPs, irrespective of their latency. In controls, only few MEPs with a latency of 225 ms were found in 4 out of 12 subjects.

CONCLUSIONS

The pattern of MEPs found in CH patients differs dramatically from that reported in adult stroke patients, suggesting that long-latency MEPs are a rather distinctive consequence of early corticospinal lesions. The hypothesis that a given cluster of long-latency MEPs is mediated by a particular pathway appears very unlikely. Rather, we suggest that an exacerbation of cortical and/or spinal excitability is at the origin of these long-latency MEPs.