Abnormalities of short-latency somatosensory evoked potentials in parkinsonian patients

Evidence for an abnormal cortical sensory processing in dystonia: selective enhancement of lower limb P37-N50 somatosensory evoked potential

We evaluated brain stem P30, contralateral frontal N37, and the vertex-ipsilateral central P37, N50 somatosensory evoked potentials (SEPs) obtained in response to stimulation of the tibial nerve in 10 patients with idiopathic dystonia. Results were compared with those obtained in 10 healthy subjects matched for age and sex. The amplitude of the brain stem P30 potential and of the contralateral frontal N37 response in dystonic patients was not significantly different from that recorded in normal subjects. The vertex- ipsilateral central P37-N50 complex, which is thought to originate in the pre-rolandic cortex, was significantly enhanced in patients compared with the control group. These results suggest the enhancement of the vertex-ipsilateral central P37-N50 complex might reflect an abnormal response to somatosensory inputs of a precentral cortex which is excessively activated because of a disorder of the basal ganglia. Such inefficient sensory processing in motor areas might contribute to motor impairment in dystonia.

Parkinson's disease and lower limb somatosensory evoked potentials: apomorphine-induced relief of the akinetic-rigid syndrome and vertex P37-N50 potentials

We evaluated brainstem P30, vertex-central P37-N50 and contralateral frontal N37 somatosensory evoked potentials (SEPs) from the tibial nerve in 14 patients affected by Parkinson's disease (PD) with akinetic-rigid syndrome. In seven patients SEPs were recorded after administration of apomorphine. The cortical P37-N50 complex was either absent (five patients, eight tested sides) or significantly smaller in patients as compared to the control group (n = 18). There was a relationship between abnormalities of early vertex potentials and degree of motor impairment. Administration of apomorphine was followed by an increase in amplitude of P37-N50 response, which was maximal after 15-30 min and then progressively returned to basal values in parallel with clinical improvement. Amplitude of brainstem P30 and frontal N37 responses was within normal values and did not vary following drug administration. These results suggest that the P37-N50 complex arises from independent cortical generators, probably located in the pre-rolandic cortex, which may be selectively affected by basal ganglia dysfunction. Amplitude decrease of the P37-50 complex may reflect an abnormal processing of somatosensory inputs within the pre-central cortex due to defective modulation exerted by basal ganglia circuitry on cortical excitability. SEP potentiation following apomorphine, besides indicating that this dysfunction is partly reversible, might suggest objective method to measure therapeutic efficacy.

Autosomal recessive rolandic epilepsy with paroxysmal exercise-induced dystonia and writer's cramp: delineation of the syndrome and gene mapping to chromosome 16p12-11.2

We describe a pedigree in which 3 members in the same generation are affected by Rolandic epilepsy (RE), paroxysmal exercise-induced dystonia (PED), and writer's cramp (WC). Both the seizures and paroxysmal dystonia had a strong age-related expression that peaked during childhood, whereas the WC, also appearing in childhood, has been stable since diagnosis. Genome-wide linkage analysis performed under the assumption of recessive inheritance identified a common homozygous haplotype in a critical region spanning 6 cM between markers D16S3133 and D16S3131 on chromosome 16, cosegregating with the affected phenotype and producing a multipoint LOD score value of 3.68. Although its features are unique, this syndrome presents striking analogies with the autosomal dominant infantile convulsions and paroxysmal coreoathetosis (ICCA) syndrome, linked to a 10 cM region between D16S401 and D16S517, which entirely includes the 6 cM of the RE-PED-WC critical region. The same gene may be responsible for both RE-PED-WC and ICCA, with specific mutations explaining each of these Mendelian disorders. This report shows that idiopathic focal disorders such as epilepsy and dystonia, can be caused by the same genetic abnormality, may have a transient expression, and may be inherited as an autosomal recessive trait.

Neurophysiological abnormalities in the Westphal variant of Huntington's disease

The Westphal variant of Huntington's disease (HD) is a distinct clinical entity of HD characterized by a rigid-hypokinetic syndrome and is often associated with a juvenile onset of disease. Definite genetic differences between the subtypes of HD have not been delineated so far. Here we present the results of a battery of neurophysiological tests including somatosensory-evoked potentials, blink reflexes, long-latency reflexes, and measurement of saccadic velocities in a Westphal HD patient. Although quantitative assessment of his motor performance showed a severe hypokinetic syndrome resembling Parkinson's disease, the results of somatosensory-evoked potentials and blink reflexes were indistinguishable from results obtained in hyperkinetic HD patients. Long-latency reflexes, however, which are typically absent in hyper-kinetic HD patients, were retained in this patient. It is concluded that neurophysiology in HD patients is not a mere reflection of the patient's symptomatology but can give insight into the underlying pathophysiological process.

Scalp topography and source analysis of interictal spontaneous spikes and evoked spikes by digital stimulation in benign rolandic epilepsy

OBJECTIVES

We report the analysis of scalp topography and dipole modeling of the rolandic spikes in 6 patients suffering of benign rolandic epilepsy of childhood with extremely high amplitude SEP by tapping stimulation of the finger of the hand.

METHODS

EEG and BESA analysis were performed for both rolandic spontaneous interictal spikes and high amplitude scalp activity evoked by tapping and electrical stimulation of the first finger of the right hand.

RESULTS

The evoked responses showed a morphology characterized by a rapid phase (spike) followed by a slow phase (slow wave). The spike presented an early small positive component followed by a main negative component. Similar morphology, dipole configuration and source localization were observed for both rolandic spikes and evoked high amplitude scalp responses. Dipole localization showed an overlap of spatial coordinates between rolandic and evoked spikes.

CONCLUSIONS

These findings suggest that the extremely high amplitude SEPs could be evoked spikes which probably had the same cortical generators of the spontaneous rolandic spikes.

Postmovement beta synchronization in patients with Parkinson's disease

Event-related synchronization (ERS) after self-paced, voluntary brisk movement of the right and left thumb was studied in 17 patients with Parkinson's disease (PD) and 17 age-matched control subjects. All patients were receiving L-DOPA and/or DOPA-agonists. The movement-offset-triggered EEG data were analyzed in the 12- to 16-Hz, 16- to 20-Hz, and 20- to 24-Hz bands for eight time intervals after termination of movement. Significant differences in postmovement beta synchronization were observed in all three frequency bands. As compared with the control group, patients with PD showed a remarkably smaller beta ERS. This was the overall main effect for groups, as well as for interactions concerning side of movement and electrode positions. If beta ERS is a measure of recovery of the primary motor area after movement, our results indicate that this ability is impaired in PD patients.

Increased activation of frontal areas during arm movement in idiopathic torsion dystonia

Most positron emission tomography (PET) studies of regional cerebral function in idiopathic torsion dystonia (ITD) have failed to show abnormalities, but there have been few studies of the changes in regional cerebral blood flow (rCBF) that occur during movement in dystonia. Using PET, we have studied six patients with familial generalized ITD both at rest and while moving a joystick with the right hand. The patterns of CBF change obtained were compared with those in six age-matched control subjects. In the dystonia group, free selection of movement was associated with relative increases in rCBF above that observed in control subjects in the left premotor area, the supplementary motor area (SMA), the anterior cingulate cortex, and the left dorsolateral prefrontal area. Subcortical increases were observed within the cerebellum and the putamen. There was a relative decrease in flow through the contralateral primary sensorimotor cortex. These findings contrast with those reported in patients with Parkinson's disease undertaking the same task in which the activity in the SMA and putamen was decreased. We suggest that arm dystonia in ITD is associated with overactivity of the premotor areas, including the SMA, and that this results from release of the thalamus from the normal inhibitory influence of the globus pallidus internal segment. Other abnormalities of basal ganglia control of brain stem centers may be involved in axial dystonia.

N30 somatosensory evoked potentials in patients with unilateral Parkinson's disease

The N30 component of the somatosensory evoked responses (SEP) was reported as absent or abnormally low in various basal ganglia disorders, including Parkinson's disease (PD), but its relationship to the more affected side in asymmetric disease has not been assessed systematically. In 14 patients with unilateral PD and 10 controls, SEP were performed by stimulating each upper limb and recording from the parietal and frontal contralateral cortex. N30 was symmetric in 4 patients and 4 controls; it was asymmetric in 2 controls and in 8 patients (in 4 the responses were of lower amplitude over the affected hemisphere); no response was elicited in 2 patients and 4 controls. In all patients SEP were recorded off medication; in 9 of them the test was repeated following administration of L-dopa and did not show any significant changes. In conclusion, the N30 was asymmetric in a similar proportion of PD patients and controls. No correlation was found between the affected side and N30 latencies or amplitudes; no change was seen following L-dopa administration as well. The motor deficits and SEP abnormalities in PD probably reflect pathologies in different anatomical structures or functional circuits.

Change in lateralization of the P22/N30 cortical component of median nerve somatosensory evoked potentials in patients with cervical dystonia after successful treatment with botulinum toxin A

The precentral P22/N30 cortical component of the median nerve somatosensory evoked potentials (SEPs) was recorded in 16 patients (11 women and five men) suffering from cervical dystonia before and after botulinum toxin therapy. Cervical dystonia was diagnosed as idiopathic in all patients: 13 patients suffered from right-sided torticollis, and three suffered from left-sided torticollis. The amplitude of the P22/N30 component and the side-to-side ratio of amplitude values were measured. Normal values were obtained by acquiring measurements in two groups of healthy volunteers (n1 = 20 and n2 = 20). The recordings in the first control group were done with the patient's head in a normal position, whereas, in the second control group, the patient kept the head intentionally rotated 60 degrees to the right. Patients were treated with local injections of botulinum toxin A (BTX-A). The mean duration of treatment was 8.3 months, and the mean total amount of BTX injected was 295 U. The P22/N30 precentral component was repeatedly recorded in patients after head posture had been corrected to the normal plane by BTX-A treatment. The recordings showed that the amplitude of the P22/N30 precentral component recorded contralaterally to the direction of head deviation was significantly higher in patients before treatment than after treatment. Contralateral pretreatment amplitudes were also significantly higher (p < 0.01 and p < 0.05, respectively) than amplitudes in both groups of healthy volunteers. The mean side-to-side ratio of precentral P22/N30 component amplitudes was significantly higher in patients before treatment compared with after treatment and also compared with both control groups. These changes in dystonic patients probably reflect the direction of head rotation, the muscle pattern of torticollis, and the change in force of dystonic contraction after the treatment. The changes presumably could be the result of higher excitability of the precentral cortex contralateral to head rotation in patients with cervical dystonia and its change after successful BTX-A treatment.

Lateralization of the P22/N30 component of somatosensory evoked potentials of the median nerve in patients with cervical dystonia

Somatosensory evoked potentials (SEPs) of the median nerve were recorded in 40 patients suffering from cervical dystonia and in 40 healthy volunteers as a control. Before recording the median nerve SEPs, polymyographic recordings were performed in all patients with cervical dystonia. The activity of cervical muscles was recorded, and the leading muscle of cervical dystonia was determined. Patients were divided into two groups according to the results of polymyography. The leading muscle was sternocleidomastoid in the first group and the splenius capitis in the second group. Patient SEPs were recorded during abnormal head rotation. SEPs in 20 healthy volunteers were recorded with the head in the middle position. SEPs of another 20 healthy volunteers were recorded with the head rotated 60 degrees to the right. The mean peak-to-peak amplitude values of the precentral P22/N30 complex and the mean ratio of the P22/N30 amplitudes between both hemispheres were calculated in the F3 (F4) and C3' (C4') electrode positions in all four groups. No significant lateralization of the precentral P22/ N30 component was found in either group of healthy volunteers. In dystonic patients in whom the sternocleidomastoid was determined as the leading muscle of dystonia, a statistically significant lateralization of the P22/N30 component toward the ipsilateral side of the leading muscle was found. In the group with the splenius capitis determined as the leading muscle of dystonia, a statistically significant lateralization of the P22/N30 component toward the contralateral side of the leading muscle was found. The possibility that the precentral cortex is activated differently in cervical dystonia patients who have different muscle patterns of dystonia is discussed.

Sensory and motor evoked potentials in multiple system atrophy: a comparative study with Parkinson's disease

Somatosensory evoked potentials (SEPs) to median nerve stimulation and motor evoked potentials to transcranial magnetic stimulation (TMS) of the motor cortex were studied in 15 patients with multiple system atrophy (MSA) and compared with matched groups of 20 patients with idiopathic Parkinson's disease (PD) and of 20 normal controls (NCs). No SEP latency or amplitude abnormalities were observed, and, in particular, the frontal N30 component was not significantly depressed. No differences in TMS threshold for evoking responses in relaxed or active thenar muscles were observed. The mean central motor conduction time was normal for the biceps brachii and opponens pollicis muscles and prolonged in the MSA group for the tibialis anterior muscle. Recording SEPs is not useful to differentiate MSA from PD, while the presence of central motor conduction abnormalities may bring into question the diagnosis of idiopathic PD.

Somatosensory evoked potentials in adults with cortical dysgenesis and epilepsy

Cortical dysgenesis (CD) is a well-recognised cause of epilepsy, but its functional anatomy is not fully understood. We recorded cortical somatosensory evoked potentials (SEPs) in 13 adult patients with epilepsy and various CDs excluding diffuse gyral malformations as diagnosed by MRI. The CD involved the perirolandic/perisylvian region in 7 patients. Six patients had neurological signs but only 3 had sensory dysfunction (astereognosis). As compared with 12 control subjects, SEPs were considered definitely abnormal in 7 patients (including the 6 with neurological signs) and equivocally abnormal in 2. The abnormalities ranged from defects affecting single components to absence of all potentials of cortical origin in one patient with hemiparesis and astereognosis. In this case it appears that gross sensory function must have been mediated by subcortical structures or through diffuse cortical projections. The initial cortical potentials (N20/P20) were absent in 6 patients, 5 of whom had CD in zones involving or bordering on the primary sensory cortex. Parietal potentials following N20 were absent or attenuated in 4 patients and of abnormally wide distribution, spreading to frontal, midline and ipsilateral electrodes, in 3 frontal components following P20 were absent, attenuated, delayed or distorted by abnormal spread of the parietal activity in 5 patients. Five patients with unilateral CD showed definite or equivocal SEP abnormalities to stimulation of both arms, suggesting there may be more widespread disturbance of cortical organisation and/or synaptogenesis, beyond the resolution of present day neuroimaging.

High resolution EEG: a new model-dependent spatial deblurring method using a realistically-shaped MR-constructed subject's head model

This paper presents a new model-dependent method for the spatial deblurring of scalp-recorded EEG potentials based on boundary-element and cortical imaging techniques. This model-dependent spatial deblurring (MDSD) method used MR images for the reconstruction of the subject's head model, and a layer of 364 radially-oriented equivalent current dipoles as a source model. The validation of the MDSD method was performed on simulated potential distributions generated from equivalent dipoles oriented radially, obliquely, and tangentially to the head surface. Furthermore, this method was used to localize neocortical sources of human movement-related and somatosensory-evoked potentials. It was shown that the new MDSD method improved markedly the spatial resolution of the simulated surface potentials and scalp-recorded event-related potentials. The spatial information content of the scalp-recorded EEG potentials increased progressively by increasing the spatial sampling from 28 to 128 channels. These results indicate that the new method could be satisfactorily used for high resolution EEG studies.

Long-term practice effects on a new skilled motor learning: an electrophysiological study

Cortical functions concerned with the execution of skilled movements can be studied through complex interactive tasks. Skilled performance task (SPT) offers the greatest deal of information about the electrophysiological components reflecting pre-programming, execution of the movement and control of the results. Overall, these components are indicated as "movement-related brain macropotentials' (MRBMs). Among them, Bereitschaftspotential (BP) reflects cerebral processes related to the preparation of movement and skilled performance positivity (SPP) reflects control processes on the result of performance. There is some evidence supporting a training effect on MRBMs, but less clear is whether long-term practice of a skilled activity could modify learning strategies of a new skilled task. We recorded MRBMs in subjects trained for a long time to perform a highly skillful athletic activity, i.e. gun shooting, and in a group of control subjects without any former experience in skilled motor activities. Our findings demonstrated the existence of a relationship between pre-programming and performance control, as suggested by decrease of BP amplitude and increase of SPP amplitude in presence of high levels of performance. Long-term practice seems to develop better control models on performance, that reduce the need of a high mental effort in pre-programming a skilled action.

Somatosensory evoked potentials during the ideation and execution of individual finger movements

Scalp somatosensory evoked potentials (SEPs) were recorded in 10 volunteers after median nerve stimulation, in four experimental conditions of hand movements performance/ideation, and compared with the baseline condition of full relaxation. The experimental conditions were (a) self-improvised hand-finger sequential movements; (b) the same movements according to a read sequence of numbers; (c) mental ideation of finger movements; and (d) passive displacement of fingers in complete relaxation. Latencies and amplitudes of the parietal (N20, P25, N33, and P45) and frontal peaks (P20-22, N30, and P40) were analyzed. Latencies did not vary in any of the paradigms. Among the parietal complexes, only the P25-N33 amplitude was significantly reduced in (a), (b), (c), and (d) and the N20-P25 was reduced in (a) and (d); among frontal waves, N30 and P40 were significantly reduced (20-75%) in (a) and (b). Coronal electrodes showed amplitude decrements maximal at the frontal-rolandic positions contralateral to the stimulated side.

Median nerve somatosensory evoked potentials. Apomorphine-induced transient potentiation of frontal components in Parkinson's disease and in parkinsonism

Somatosensory evoked potentials (SEPs) to median nerve stimulation have been recorded from parietal and frontal districts in 43 parkinsonians, 17 patients with parkinsonism and 35 healthy controls matched for age and sex. Latency/amplitude characteristics of the parietal P14-N20-P25 and of the frontal P20-N30-P40 wave complexes before and after (10, 20, 30 and 60 min) subcutaneous administration of apomorphine chloride were evaluated in all the 60 patients and in 3 controls. The frontal waves N30 and P40 were either absent or significantly smaller than normal in 31 patients with Parkinson's disease (PD) (72.1%) and in 9 with parkinsonism in baseline records (56.3%). Following apomorphine, the parietal deflections did not significantly vary in amplitude. On the contrary, the frontal complex showed a significant amplitude increase in 27 PD and 8 parkinsonisms (respectively 62.8 and 47.1%); 79.1% of PD and 35.3% of parkinsonisms were improved clinically. Amplitude increase was evident at 10 min after apomorphine, in parallel with clinical improvement, and vanished nearly in coincidence with the end of the clinical effect.

Gating of somatosensory evoked responses during active finger movements magnetoencephalographic studies

The "gating" effects caused by active finger movements on somatosensory evoked magnetic fields (SEFs) following stimulation of the median nerve were examined in normal subjects. The effects of the interfering stimulus were best demonstrated by subtracting the "interference" wave forms from the "control" wave forms to derive the "difference" wave form. The short-latency cortical deflections, N20m-P20m, P30m-N30m and P25m-N35m were significantly attenuated with no latency changes. In contrast, the following middle-latency deflections, the N40m-P40m and the P60m-N60m were clearly changed in terms of latency and duration by the interference. The D30m-U30m and the U60m-D60m in the "difference" wave form were derived from these interference changes. It is considered that the gating effects on all deflections took place in the hemisphere contralateral to the stimulated median nerve, because all of the equivalent current dipoles (ECDs) of the short- and the middle-latency deflections in the "control", "interference" and "difference" wave forms were located there. The gating effects on the short-latency deflections were suggested to be due to the interactions between the neurons in areas 1 and 3b, which were activated by sensory inputs from cutaneous mechanoreceptors, and the neurons in area 3a which were activated by sensory inputs from the muscle spindles. The gating effects on the middle-latency deflections may mainly be due to the excitations of neurons in area 4 caused by either continuous movement-related activities or by sensory inputs spreading from the sensory cortex.

Dissociated changes of frontal and parietal somatosensory evoked potentials in sleep

We studied the changes of frontal and parietal somatosensory evoked potentials (SEPs) in the awake state versus different stages of sleep in 10 normal adult subjects. Frontal and parietal SEP components were affected differentially as sleep stages progressed. In general, the amplitudes of frontal components, notably P22, were increased in sleep, whereas the amplitudes of parietal components were decreased in sleep. A sensitive waveform change from the awake state to sleep was present in the frontal response, where a subtle notched negativity, termed "N40," was present only in the awake state and quickly dissipated in all stages of sleep, including stage 1. The amplitude changes from the awake state to stage 3/4 sleep were neither linear nor parallel among SEP components. The most discordant changes occurred in stage 3/4. The amplitudes for the frontal N18-P22-N30 complex and parietal N20-P26-N32 complex increased from stage 2 to stage 3/4, while those for frontal N30-fP40 and parietal N32-pP40 decreased. In contrast to these divergent amplitude changes, the latencies of all components except P14 and frontal N18 showed progressive prolongation from the awake state to slow-wave sleep. The SEP waveforms and latencies in REM sleep approximated those in the awake state, although amplitudes for frontal peaks still remained slightly higher and amplitudes for parietal peaks slightly lower. We postulate that interactions of excitatory and inhibitory phenomena are responsible for the component-dependent and sleep-stage-dependent amplitude enhancement or depression in sleep.

The abnormality of N30 somatosensory evoked potential in idiopathic Parkinson's disease is unrelated to disease stage or clinical scores and insensitive to dopamine manipulations

We recorded short latency somatosensory evoked potentials (SEPs) to median nerve stimuli in 40 patients affected by idiopathic Parkinson's disease (PD) classified from I to IV on the Hoehn and Yahr disability scale. SEPs were recorded before and after chronic administration of L-Dopa and bromocriptine, before and after acute administration of L-Dopa. Fourteen patients experiencing wearing off and dystonic-dyskinetic disturbances were recorded during the occurrence of these oscillations of their clinical status. Absent or reduced N30 components were found in 32.5% of patients. SEPs were not modified by acute or chronic administration of L-Dopa or bromocriptine or during off and dystonic or dyskinetic conditions. Multiple correlations of N30 with scores of the Unified Parkinson's Disease Rating Scale showed that N30 abnormality did not classify patients with prominent clinical features, nor did it predict the outcome of treatment.

BIT-mapped somatosensory evoked potentials in the fragile X syndrome

Middle-latency somatosensory evoked potentials (MLSEPs) were recorded from 19 scalp electrodes in ten male patients with the fragile X (fraX) syndrome and nine normal controls. One fraX patient was found presenting the so-called "giant" MLSEPs with an amplitude of N60 of about 60 microV and of 40 microV after stimulation of the right and left median nerves, respectively. Tapping of the right hand, in the same patient, induced the appearance of left parietal evoked EEG spikes. These findings further support the already suggested similarity between the epileptic picture of several fraX patients with that of the benign childhood epilepsy with centrotemporal spikes. Color mapping of the MLSEPs recorded in the remaining nine patients, when compared with the control group, showed an abnormally large N30 over the frontal regions, together with an increase in amplitude of P27, over the parietal areas, and of N60 and P100 which also presented abnormal field distributions, being represented preferentially over the frontal regions. These data could suggest the existence of a cortical dysfunction mostly involving the frontal lobes (supplementary motor area, in particular) in the fraX syndrome which could support many behavioral changes usually observed in these patients.

Somatosensory evoked potentials at rest and during movement in Parkinson's disease: evidence for a specific apomorphine effect on the frontal N30 wave

Studies attempting to relate the abnormalities of the frontal N30 components of the somatosensory evoked potentials (SEPs) to motor symptoms in Parkinson's disease (PD) have shown contradictory results. We recorded the frontal and parietal SEPs to median nerve stimulation in 2 groups of PD patients: a group of 17 patients presenting the wearing-off phenomenon, and a group of 10 untreated PD patients. The results were compared with a group of 13 healthy volunteers of the same age and with a group of 10 non-parkinsonian patients. All parkinsonian and non-parkinsonian patients were studied before ("off" condition) and after a subcutaneous injection of apomorphine ("on" condition). The gating effects of a voluntary movement (clenching of the hand) on the SEPs were also studied for the wearing-off group of PD patients (in states off and on) in comparison with the healthy subjects. At rest and in the off condition the amplitude of the frontal N30 was significantly reduced in the 2 groups of PD patients. We demonstrate that the movement gating ability of the PD patient is preserved in spite of the reduced amplitude of the frontal N30. This result suggests that the specific change in the frontal N30 in PD is not the consequence of a continuous gating of the sensory inflow by a motor corollary discharge. Clinical motor improvement induced by apomorphine was associated with a significant enhancement of the frontal N30 wave. In contrast, the subcortical P14 and N18 waves and the cortical N20, P22, P27 and N45 were not statistically modified by the drug. Apomorphine infusion did not change the absolute reduced voltage of the N30 reached during the movement gating. While the frontal N30 component of the non-parkinsonian patients was significantly lower in comparison to healthy subjects, this wave did not change after the apomorphine administration. In the wearing-off PD patient group the frontal N30 increment was positively correlated with the number of off hours per day. This specific apomorphine sensitivity of the frontal N30 was interpreted as a physiological index of the dopaminergic modulatory control exerted on the neuronal structures implicated in the generation of the frontal N30.

Somatosensory evoked magnetic fields following median nerve stimulation

Topography of somatosensory evoked magnetic fields (SEFs) following stimulation of the median nerve were investigated in normal subjects. N20m-P30m-N40m-P60m and their counterpart, P20m-N30m-P40m-N60m, were identified in the hemisphere contralateral to the stimulated median nerve. Their equivalent current dipoles (ECDs) were considered to be located in the hand area of area 3b in the primary sensory cortex (SI). Restricted deflections, P25m and N25m, were considered to be generated in area 1 in SI. Therefore, short-latency deflections less than 40 ms were considered to be hybrids of ECDs generated in areas 3b and 1. Middle-latency deflections, N90m-P90m, were considered to be generated in the second sensory cortex (SII), but they were greatly affected by the much stronger fields generated in SI. The N30m deflection, which was a magnetic reflection of the N30 potential of somatosensory evoked potentials (SEPs), were widely recorded in the frontal area. The generator site of N30 of SEPs is considered to be the supplementary motor area (SMA). However, ECDs of N30m were located in SI, and no significant ECD generated in the frontal area including SMA was detected. No significant deflections other than small N90m-P90m in SII were identified in the hemisphere ipsilateral to the stimulated nerve. No significant deflections whose ECDs were generated in the mid-parietal area were identified. In conclusion, short- and middle-latency SEFs are mainly generated in area 3b in SI contralateral to the stimulated median nerve, and responses generated in area 1 of SI and SII affect the SEFs to some degree.

Statistical analysis of topographic maps of short-latency somatosensory evoked potentials in normal and parkinsonian subjects

This work had the following objectives: i) to integrate temporal analysis (N30 peak) with power-spectrum topographic mapping of short-latency somatosensory evoked potentials (SEP's) recorded in parkinsonian and normal control subjects; and ii) to analyze with a new statistical approach the between-group topographical differences in both the time and frequency domains. The principal aim was to better determine the topography of the scalp frontal areas where the amplitude of the N30 wave was previously found to be significantly reduced in parkinsonians. The statistical procedure was based on the combined use of descriptive data analysis (DDA) and multivariate analysis. In the context of DDA, an improved version of significance probability mapping (SPM) was used by which it is possible to evaluate homo- and nonhomoscedastic data with parametric tests. The statistical evaluation of between-group differences was performed with the multivariate Hotelling's T2 test and the associated post hoc test. With this statistical procedure, it was possible to determine that the between-group statistical differences in both the temporal and power spectrum distributions were localized only in midline and contiguous contralateral frontal areas of the scalp.

Abnormalities of somatosensory evoked potentials in spasmodic torticollis

This study examined the N20 and N30 waves of somatosensory evoked potentials (SEPs) from median nerve stimulation at three different stimulation rates (1, 3, and 6 Hz) in patients with idiopathic spasmodic torticollis (ST). The data were compared with those collected from a group of patients affected by Parkinson's disease (PD) and normal age-matched subjects. N30 amplitude was significantly decreased in both groups of patients with respect to the controls. The decrease was larger in patients with ST. The N20 wave remained stable. The latencies of both waves were unchanged. When the stimulus rate was increased, the N30 amplitude decreased significantly, with a similar trend observed in both patients and controls. The isolated abnormalities of the N30 wave in both ST and PD support the hypothesis of a common physiopathogenetic mechanism that involves the basal ganglia or their connections with the supplementary motor area.

Source analysis of median nerve and finger stimulated somatosensory evoked potentials: multichannel simultaneous recording of electric and magnetic fields combined with 3D-MR tomography

At the current state of technology, multichannel simultaneous recording of combined electric potentials and magnetic fields should constitute the most powerful tool for separation and localization of focal brain activity. We performed an explorative study of multichannel simultaneous electric SEPs and magnetically recorded SEFs. MEG only sees tangentially oriented sources, while EEG signals include the entire activity of the brain. These characteristics were found to be very useful in separating multiple sources with overlap of activity in time. The electrically recorded SEPs were adequately modelled by three equivalent dipoles located: (1) in the region of the brainstem, modelling the P14 peak at the scalp, (2) a tangentially oriented dipole, modelling the N20-P20 and N30-P30 peaks, and part of the P45, and (3) a radially oriented dipole, modelling the P22 peak and part of the P45, both located in the region of the somatosensory cortex. Magnetically recorded SEFs were adequately modelled by a single equivalent dipole, modelling the N20-P20 and N30-P30 peaks, located close to the posterior bank of the central sulcus, in area 3b (mean deviation: 3 mm). The tangential sources in the electrical data were located 6 mm on average from the area 3b. MEG and EEG was able to locate the sources of finger stimulated SEFs in accordance with the somatotopic arrangement along the central fissure. A combined analysis demonstrated that MEG can provide constraints to the orientation and location of sources and helps to stabilize the inverse solution in a multiple-source model of the EEG.

Behavioral and electrophysiological correlates of the quinolinic acid rat model of Huntington's disease in rats

The influence of bilateral intrastriatal injection of quinolinic acid (QA, 300 nmol) was studied in male Wistar rats. Behavioral and electrophysiological experiments were conducted in 15 lesioned plus 15 vehicle-injected (control) animals. With respect to control animals, QA-lesioned rats showed marked, statistically significant alterations from both the behavioral (greater motor activation in response to d-amphetamine, place-learning deficit in the Morris water maze), and the electroencephalographic (reduced voltage amplitude and EEG power at the level of frontal cortex) points of view. In addition, a significant loss in body weight and a marked striatal gliosis (GFAP staining) were observed in lesioned rats. Conversely, QA-lesioned rats did not show modifications in posttetanic potentiation (P.T.P.) or long-term potentiation (L.T.P.) in CA1 hippocampal area. The present results confirm that QA lesions of rat striatum may be regarded as a suitable model of Huntington's disease (HD).

Somatosensory evoked potentials induced by stimulating a variable number of nerve fibers in rat

Somatosensory evoked potentials (SEPs) were recorded from rat spinal cord (sSEPs) and cerebral cortex (cSEPs). Stimulus sites included either one or both sural nerve branches having different fiber populations (group A), or distal to a lesion of controlled size of the sural nerve made 1 week earlier (group B). In the two groups of animals, amplitudes of SEPs correlated with the quantity of large myelinated nerve fibers. Peak latencies of sSEPs in group A related to the ratio of sizes of transmitting fibers. sSEPs and cSEPs in both groups A and B could be recorded in a reproducible fashion by stimulating sural nerve branches or lesioned nerve trunks containing only 100 or less nerve fibers greater than 4 microns in size. Thus, presence of sSEPs or cSEPs after stimulation distal to a lesion site does not insure that many nerve fibers have continuity with the central nervous system (CNS).

Pre- and postcentral cortical somatosensory evoked potentials in hemiparkinsonism

We recorded cortical frontal, central, and parietal somatosensory evoked potentials (SEPs) in 9 patients with hemiparkinsonism and in a group of 25 healthy volunteers. No differences were observed in the SEPs recorded after stimulation of the asymptomatic and symptomatic sides in the patients. Likewise, comparison with the healthy controls did not reveal significant group differences or abnormal waveforms in the patients. Even frontal N30 deflection, which has been reported to be diminished in Parkinson's disease (PD), was normal and symmetric in the patients. Therefore, no evidence was found for altered sensory input to the motor or premotor and supplementary motor cortices in PD.

Dissociation of frontal and parietal components of somatosensory evoked potentials in severe head injury

Reports on the topography of SEPs in non-comatose patients have drawn attention to a second thalamo-cortical loop connecting the thalamus with the frontal cortex, which has a close anatomical relation to the fronto-limbic structures frequently damaged in severe head injury (SHI). We studied whether the frontal component (P20/22) of the somatosensory evoked response (SEP), known to be due to a generator different from that of the traditionally analysed parietal SEP component (N20), would be differently affected by SHI. Moreover, we examined whether its analysis would improve the prognostic evaluation in the Glasgow outcome scale (GOS) after 3-6 months. In 50 patients examined within 72 h after the injury we found a dissociated impairment of frontal and parietal components in 24% of the recorded SEPs. When both frontal and parietal components were used as predictors, discriminant analysis correctly classified 94% of the patients into good (GOS good recovery and moderate disability) or poor (GOS severe disability, persistent vegetative state or death) outcome groups. Classification was less accurate and misclassifications grosser when considering parietal or frontal parameters alone. Our results show that (i) the evaluation of frontal components provides information different from that of the parietal SEPs, confirming the presence of different generators, and (ii) a combined analysis of the two components improves the prognostic evaluation with regard to the global outcome.

Physiology of basal ganglia disorders: an overview

The pathophysiology of the movement disorders arising from basal ganglia disorders has been uncertain, in part because of a lack of a good theory of how the basal ganglia contribute to normal voluntary movement. An hypothesis for basal ganglia function is proposed here based on recent advances in anatomy and physiology. Briefly, the model proposes that the purpose of the basal ganglia circuits is to select and inhibit specific motor synergies to carry out a desired action. The direct pathway is to select and the indirect pathway is to inhibit these synergies. The clinical and physiological features of Parkinson's disease, L-DOPA dyskinesias. Huntington's disease, dystonia and tic are reviewed. An explanation of these features is put forward based upon the model.

Suppression of magnetic mu rhythm during parkinsonian tremor

We recorded spontaneous magnetoencephalographic (MEG) activity and somatosensory-evoked fields (SEFs) with a 24-channel planar SQUIDgradiometer in five patients with hemiparkinsonism. The SEFs of the patients were within normal limits. During tremorless periods, the spontaneous activity over the somatomotor cortex had a frequency peak at approximately 10 Hz in all five patients and another at approximately 20 Hz in three. Tremor dampened the 10-Hz activity in all patients; in three the effect was bilateral. Tremor did not increase MEG activity at the tremor frequency. The suppression of the mu rhythm by the parkinsonian tremor resembled that occurring during voluntary movements in healthy subjects.

Apomorphine-induced relief of the akinetic-rigid syndrome and early median nerve somatosensory evoked potentials (SEPs) in Parkinson's disease

Among early cortical median nerve SEPs the frontal N30 potential is known to show amplitude reduction during execution of voluntary movements and to be abnormally reduced in parkinsonian patients. However, it is not clear whether N30 abnormalities are related to the severity of motor disability in Parkinson's disease. To address this question we studied median nerve SEPs, using a 16-channel montage, in 7 patients chronically treated with subcutaneous (s.c.) injections of apomorphine hydrochloride for spontaneous "on-off" motor fluctuations. We observed no significant changes in the latency, amplitude or scalp topography of early SEPs when comparing traces and maps obtained in the "off" condition and during the "on" phase induced by s.c. injection of apomorphine. The absence of any SEP changes, despite a clear-cut relief of the akinetic-rigid syndrome, suggests that early cortical SEPs, and in particular the frontal N30 potential, at least when recorded in a subject at rest, are not usable as an objective means to assess the severity or the fluctuations of motor disability in Parkinson's disease.

Event-related potentials in Parkinson's disease: a 12-month follow-up study

Auditory event-related potentials were recorded using the oddball paradigm in 26 patients with Parkinson's disease, all treated with L-Dopa. The latency of the P3 wave was significantly greater than in an age-matched controls, and was also correlated with the disease duration, but not with scores on two scales measuring cognitive deficit. One year later, when treatment with a dopaminergic agonist, bromocriptine 20-30 mg/day, had been added to the therapeutic regimen, N2 and P3 latencies had increased, whereas several clinical parameters had improved. Thus a longer P3 latency does not seem to be linked to a global cognitive deficit. The use of neuropsychological tests exploring more limited tasks should show the prospective utility of event-related potentials in Parkinson's disease.

Dipole modelling of median nerve SEPs in normal subjects and patients with small subcortical infarcts

Somatosensory evoked potentials (SEPs) to median nerve stimulation were analyzed by means of spatio-temporal dipole modelling in 6 normal subjects and 8 patients with small infarcts in the thalamo-cortical radiation or thalamus. The SEPs could be modelled by a tangentially and a radially oriented equivalent dipole in the region of the contralateral cortical hand area and an equivalent dipole located in the region of the brain-stem. In 3 patients with absence or reduction of amplitudes of cortically generated SEP components, the activity of both cortical dipoles was lost or reduced. In 2 patients the frontally recorded SEP component P20 was lost; in one of them the activity of mainly the tangential dipole was reduced.

Impaired mesial frontal and putamen activation in Parkinson's disease: a positron emission tomography study

Selection of movement in normal subjects has been shown to involve the premotor, supplementary motor, anterior cingulate, posterior parietal, and dorsolateral prefrontal areas. In Parkinson's disease (PD), the primary pathological change is degeneration of the nigrostriatal dopaminergic projections, and this is associated with difficulty in initiating actions. We wished to investigate the effect of the nigral abnormality in PD on cortical activation during movement. Using C15O2 and positron emission tomography (PET), we studied regional cerebral blood flow in 6 patients with PD and 6 control subjects while they performed motor tasks. Subjects were scanned while at rest, while repeatedly moving a joystick forward, and while freely choosing which of four possible directions to move the joystick. Significant increases in regional cerebral blood flow were determined with covariance analysis. In normal subjects, compared to the rest condition, the free-choice task activated the left primary sensorimotor cortex, left premotor cortex, left putamen, right dorsolateral prefrontal cortex and supplementary motor area, anterior cingulate area, and parietal association areas bilaterally. In the patients with PD, for the free-choice task, compared with the rest condition, there was significant activation in the left sensorimotor and premotor cortices but there was impaired activation of the contralateral putamen, the anterior cingulate, supplementary motor area, and dorsolateral prefrontal cortex. Impaired activation of the medial frontal areas may account for the difficulties PD patients have in initiating movements.

The N30 component of somatosensory evoked potentials in patients with dystonia

We recorded short-latency median nerve somatosensory evoked potentials (SEPs) in 10 patients with dystonia (6 with focal dystonia, 3 with generalized dystonia, and 1 with segmental dystonia) and compared them with those of 10 normal controls. The EEG was recorded from 29 sites on the scalp with linked earlobe electrodes for reference. Latencies and amplitudes of P15, postcentral N20 and P45, and frontal N30 were evaluated. The latencies of all potentials were the same in patients and controls. The amplitudes of P15, N20 and P45 were also the same in both groups, but the N30 amplitude of the patients was larger than of the controls. The amplitude of N30 did not vary from the affected side to the unaffected side. Previous work has shown decreased N30 amplitude in patients with Parkinson's disease. Changes in N30 amplitude may be indicative of abnormal excitatory effects on cortex resulting from disorders of the basal ganglia.

Mental movement simulation affects the N30 frontal component of the somatosensory evoked potential

It is known that somatosensory evoked potentials can be influenced by several centripetal and centrifugal factors which modify their amplitude. The present study shows for the first time that the frontal waves N30 and to a lesser extent N23 are specifically attenuated during mental movement simulation (MMS) activity. This gating phenomenon, tested on 16 normal subjects, occurred when repeated fast finger movements on the stimulated side are mentally simulated. In contrast, no significant modification appeared when the subject performed the MMS activity with the hand contralateral to that receiving electrical stimuli or when the subject performed a mental operation unrelated to the MMS. The MMS was shown by Roland et al. (1980) to increase the regional blood flow exclusively in the supplementary motor area (SMA). Our experimental data therefore indicate that the SMA could play an important role in the generation of the frontal N30.

Recovery functions of somatosensory evoked potentials in parkinsonian patients

The aim of this study was to analyze the recovery functions of median nerve somatosensory evoked potentials (SEPs) and to clarify changes in the somatosensory system of patients with Parkinson's disease (PD). The central and frontal SEPs and the nerve potential of the median nerve were examined. The latencies and amplitudes of SEPs produced by a single shock in patients with PD were normal. The recovery functions of central SEPs showed a low degree of suppression in patients with PD, although the recovery curve of the nerve potential in PD patients was almost normal. The change in recovery curves of SEPs in patients with sensory complaints were more noticeable than that in patients without sensory disturbance. A low degree of suppression of central SEPs might play a role in the sensory complaints of PD patients.

Tactile interference differentiates sub-components of N20, P20 and P29 in the human cortical surface somatosensory evoked potential

Somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded from up to 64 locations on the exposed cortical surface in 19 patients undergoing intracranial surgery for epilepsy and/or tumour removal. In view of previously described 'interference' effects on scalp SEPs, a continuous light tactile stimulus was applied to the palm and the first 3 digits of the stimulated hand in order to try to differentiate components due to input from cutaneous and other sensory receptors. The first cortically generated potentials, N20 at postcentral locations and P20 precentrally, could each be resolved into 2 subcomponents separated by about 2.5 msec. The later subcomponent was consistently the more attenuated by the interfering stimulus and is postulated to be due to input from rapidly adapting cutaneous mechanoreceptors. The earlier subcomponent could be due to input from muscle afferents or from slowly adapting cutaneous receptors which the interfering stimulus would have activated to a lesser degree. In 2 cases the P29 potentials recorded from regions of the postcentral gyrus were dissociated. In one case the potentials recorded at adjacent electrodes were attenuated to differing degrees, and in the other the effect was maximal at different locations when the thumb, index and middle fingers were stimulated separately. The method therefore appears capable of distinguishing regions of the postcentral gyrus concerned with cutaneous input from different parts of the hand.

Unmasking of cortical SEP components by changes in stimulus rate: a topographic study

We performed topographic mapping of somatosensory responses to median nerve stimulation delivered at 2, 5 and 10 Hz. Parietal N20 was significantly attenuated in 10 Hz somatosensory evoked potentials (SEPs), while central P22 diminished between 2 and 5 Hz, remaining stable thereafter. The single component most affected by increasing stimulus rate was N30, which abated by more than 50% in 10 Hz SEPs, as compared with basal responses. N30 attenuation disclosed the existence of an earlier negative component, N24, which appeared as a notch on the N30 ascending slope in 2 Hz SEPs, but became a well-defined peak at higher stimulus rates. The N24 negativity was not significantly modified by stimulus rate; it had a parietal counterpart (P24) with the same peak latency and identical behavior during the experimental procedure. Both P24 and N24 could be differentiated from central P22 on the basis of topographical distribution and response to stimulus frequency. P22 topography could be the result of a radially oriented generator, while P24/N24 appeared as the two poles of a neural source tangential to the scalp. P27 was seen in 40% of the subjects only; it is suggested that P27 is itself a composite potential to which the generator of N30 could contribute in part. We conclude that there is no single "optimal" stimulation rate for SEP recording. On the contrary, combination of different frequencies of stimulation should enhance the diagnostic utility of this technique by allowing a more selective assessment of overlapping activities.

Gating of the early components of the frontal and parietal somatosensory evoked potentials in different sensory-motor interference modalities

Three different interfering conditions were studied during the recording of pre- and postcentral somatosensory evoked potentials (SEPs) following median nerve stimulation at the wrist in 16 normal subjects: active finger movement (MVT), light superficial massage (LSM) and deep muscular massage (DMM) of the hand. Special attention was focused on selective effects on individual SEP components. The frontal N30 component showed the most significant amplitude reduction during the three interfering conditions (76.4% of reduction in MVT, 36.4% in DMM and 32.9% in LSM). In contrast the frontal N23 was not significantly changed and the preceding P22 component was only reduced in the MVT condition. Postcentral N20 was unchanged by the three conditions while P27 was clearly gated by movement but not significantly by LSM and DMM. The three interfering conditions enhanced the parietal N32 and had no significant effect on the parietal P45. An important point was the interindividual variability of these effects and it appeared that group average wave forms would therefore be confusing. The peak latency of some SEP components was changed during the interfering conditions. The most important effect was an increase of postcentral P45 latency which was found to be related to the amplitude enhancement of N32.

Alteration of SEP topography in Huntington's patients and their relatives at risk

We studied the amplitude maps of median SEP parameters in patients with Huntington's disease (HDP) and their relatives at risk (HDF). Corresponding to the small amplitude of SEP in HDP, the power (microV2) was significantly smaller at all electrodes, and the maximum power was shifted anteriorly as a result of greater reduction of the power in the parietal than in the frontal region. In HDF, significant power reduction at the parietal region resulted in a similar anterior shift of the power to that noted in HDP. In addition to the overall reduction of SEP amplitude, the field distributions of parietal N20, frontal N29 and central N60 were significantly different in HDP, as compared to the normals. The typical relationship of the frontal positive and parietal negative fields normally present at N20 latency was lost in HDP due to the loss of the frontal P20. Frontal N29 was absent. Also N60 field shifted anteriorly. In HDF, the degree of deviation was in between those of HDP and normals. These alterations of SEP amplitude, wave form and field distribution in HDP and in some of HDF may be viewed as a result of aberrant modulatory effect exerted by the non-sensory system upon the somatosensory input.

Modification of cortical somatosensory evoked potentials during tactile exploration and simple active and passive movements

The present study compares the effects of different types of movement on median nerve somatosensory evoked potentials (SEPs) recorded from frontal, central and parietal electrodes. Test conditions included tactile exploratory movements, repetitive active and passive thumb movements and isometric contraction. All these conditions modified the SEPs in a similar manner. Parietal N20, P25, and N60, central P22 and N32, and frontal N25, N30 and P40 deflections were diminished, while later centro-parietal P40 and fronto-central N60 were unchanged. A small frontal P35 emerged during movement. The subcortical P14 was not changed in any of the conditions. The similar modulatory effects of simple active movements and of tactile exploration indicate that the modification of SEPs does not depend on the importance of proprioceptive feedback information for movement execution. As all modulatory effects were present also during passive movement, these observed effects are most likely to be caused by afferent occlusion in the ascending thalamo-cortical pathways or sensorimotor cortical cell populations.

Spatial mapping of SEP in comatose patients: improved outcome prediction by combined parietal N20 and frontal N30 analysis

The aim of this study is to evaluate whether SEP spatial mapping can improve outcome prediction in comparison to the conventional SEP recordings. Twenty patients comatose as a result of head injury or cerebral vascular disorders were submitted to 19-channel SEP mapping from median nerve stimulation. SEP recording were performed within the 4th hospital day in 18 cases and over one month from the insult in the remaining two. Nine patients (45%) showed a good recovery or a mild disability, 3 (15%) a severe disability and the rest (40%) died or remained in a vegetative state. Five patients (28%) had bilaterally normal SEP, 5 (28%) the absence of both parietal N20 and frontal N30, while the others (44%) had a dissociation N20/N30 (namely, preserved N20 with absent N30). The SEP mapping was significantly related to the outcome (P = 0.0087) and improved the outcome prediction in comparison to the conventional SEP recordings, allowing to check the presence of frontal N30: in patients with bilaterally present N20 the outcome appeared to depend upon the N30. SEP mapping proved to be a far superior prognostic indicator than the Glasgow Coma Scale. In 3 patients with midline shift on CT scan an abnormal spatial distribution of N20 was disclosed by SEP mapping. Our preliminary results suggest that SEP mapping may improve the assessment of comatose patients in comparison to the use of parietal derivations only.