Excitation of the corticospinal tract by electromagnetic and electrical stimulation of the scalp in the macaque monkey

Effects of voluntary contraction on descending volleys evoked by transcranial stimulation in conscious humans

1. The spinal volleys evoked by single transcranial magnetic or electric stimulation over the cerebral motor cortex were recorded from a bipolar electrode inserted into the cervical epidural space of three conscious human subjects. These volleys were termed direct (D) and indirect (I) waves according to their latency. 2. We measured the size and number of volleys elicited by magnetic stimulation at various intensities with subjects at rest and during 20 or 100 % maximum contraction of the contralateral first dorsal interosseous muscle (FDI). Surface EMG activity was also recorded. 3. Electrical stimulation evoked a D-wave volley. Magnetic stimulation at intensities up to about 15 % of stimulator output above threshold evoked only I-waves. At higher intensities, a D-wave could be seen in two of the three subjects. 4. At all intensities tested, voluntary contraction increased the number and size of the I-waves, particularly during maximum contractions. However, there was only a small effect on the threshold for evoking descending activity. Voluntary contraction produced large changes in the size of EMG responses recorded from FDI. 5. Because the recorded epidural activity is destined for muscles other than the FDI, it is impossible to say to what extent increased activity contributes to voluntary facilitation of EMG responses. Indeed, our results suggest that the main factor responsible for enhancing EMG responses in the transition from rest to activity is likely to be increased excitability of spinal motoneurones, rather than increases in the corticospinal volley. The latter may be more important in producing EMG facilitation at different levels of voluntary contraction.

Hemispheric differences in motor cortex excitability during a simple index finger abduction task in humans

Transcranial magnetic (TMS) and electrical (TES) stimulation was used to assess the contribution of the corticospinal pathway to activation of the first dorsal interosseous muscle (FDI) in each hand of 16 right-handed subjects. TMS was applied at relaxed threshold intensity while the subject performed isometric index finger abduction at seven force levels [0.5 N to 50% maximal voluntary contraction (MVC)]. In a separate session, TES of equivalent intensity was applied to each hemisphere in 5 of these subjects while they performed the same force-matching protocol. In the resting state, mean threshold intensity for a muscle-evoked potential (MEP) in FDI using TMS was similar for the hemispheres controlling the dominant and nondominant hands. The size of the threshold MEPs in resting FDI after TMS and TES were also similar in each hand. With TMS, contraction-induced facilitation of the MEP in FDI was significantly larger when the nondominant hand was used for index finger abduction. In the pooled data, the nondominant/dominant ratio of MEP areas (normalized to the maximum M wave) ranged from 1. 7 in the weakest contraction (0.5 N) to 1.1 in the strongest (50% MVC). Eight subjects had significant differences between hands in favour of the nondominant hand, whereas in two subjects contraction-induced facilitation of MEPs was larger in the dominant hand. In five subjects for whom detailed motor unit data were available from a previous study, lateral differences in MEP facilitation were positively correlated with differences in FDI motor unit synchronization between hands. With TES, contraction-induced facilitation of the MEP was similar in each hand, suggesting that spinal excitability was equivalent on both sides. For the group of five subjects tested with both stimulation techniques, contraction-induced facilitation of the MEP was significantly larger after TMS than that obtained with TES when the contraction was performed with the nondominant hand, but not when the dominant hand was used to perform the task. We conclude that the extent of corticospinal neuron involvement in the command for simple index finger abduction in right-handed subjects is generally greater when the nondominant hand is used, compared with the same task performed with the dominant hand.

[Applications of cortical magnetic stimulation]

In the last decade, a new electrophysiological tool has become available since the development of painless magnetic stimulators able to activate the primary motor cortex and the motor roots in conscious man. Therefore, it became possible to measure the conduction time within fast-conducting central motor pathways by substracting from the total latency of muscle responses elicited by cortical stimuli the conduction time in peripheral nerves. This technique proved sensitive enough to illustrate early abnormalities of central motor conduction in various neurological diseases such as multiple sclerosis, amyotrophic lateral sclerosis, cervical spondylotic myelopathy, degenerative ataxias or hereditary spastic paraplegias. When recorded early after stroke, motor evoked potentials are also a valuable tool to predict functional outcome. They can also illustrate subtle pathophysiological disturbances in diseases where there is no direct involvement of central motor pathways such as Parkinson's disease, dystonia or epilepsy. Magnetic cortical stimulation also offers unique opportunities to explore intracerebral inhibitory and excitatory circuits and mechanisms of brain plasticity. The recent development of rapid rate stimulators also enables functional studies of non-motor cerebral regions such as visual or frontal cortices. Moreover, rapid rate stimulation seems useful in the treatment of drug-resistant depression but the safety of this procedure, particularly with regard to the production of seizures or kindling, remains to be fully documented.

Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996

Single-pulse transcranial magnetic stimulation (TMS) is a safe and useful tool for investigating various aspects of human neurophysiology, particularly corticospinal function, in health and disease. Repetitive TMS (rTMS), however, is a more powerful and potentially dangerous modality, capable of regionally blocking or facilitating cortical processes. Although there is evidence that rTMS is useful for treating clinical depression, and possibly other brain disorders, it had caused 7 known seizures by 1996 and could have other undesirable effects. In June 1996 a workshop was organized to review the available data on the safety of rTMS and to develop guidelines for its safe use. This article summarizes the workshop's deliberations. In addition to issues of risk and safety, it also addresses the principles and applications of rTMS, nomenclature, and potential therapeutic effects of rTMS. The guidelines for the use of rTMS, which are summarized in an appendix, cover the ethical issues, recommended limits on stimulation parameters, monitoring of subjects (both physiologically and neuropsychologically), expertise and function of the rTMS team, medical and psychosocial management of induced seizures, and contra-indications to rTMS.

Central motor conduction time in malnourished children

The functional status of the descending motor pathways was assessed in malnourished children using transcranial electromagnetic stimulation of the cortex. Twenty children with different severities of malnutrition and 20 control subjects were studied electrophysiologically. The circular coil of a Dentac MAG 2 magnetic stimulator was applied tangentially over the vertex to stimulate the cortex. The muscle evoked potential in the children's arms was recorded from the abductor pollicis brevis muscle and in their legs from the extensor digitorum brevis muscle on both sides of the body using surface electrodes. The muscle evoked potential of the abductor pollicis brevis and extensor digitorum brevis muscles was further obtained using root stimulation by applying the coil at the cervical and lumbar spine, respectively. The indices of cortical threshold, cortical latency, and central motor conduction time (ms) were evaluated in both arm and leg muscles on both sides. The results showed an increased cortical threshold (mean (SD) 1232.5 (134.06) in the study group v 1147.5 (99.31) in the control group) for the abductor pollicis brevis muscle and for the extensor digitorum brevis muscle (1325.00 (115.70) in the study group v 1190.0 (125.24) in the control group). Similarly, significant prolongation of the central motor conduction time (ms) (study group 6.67 (0.91) v control group 5.71 (0.74)) in the abductor pollicis brevis muscle was seen in malnourished children.

Crossed and direct effects of digital nerves stimulation on motor evoked potential: a study with magnetic brain stimulation

We studied the influence of contralateral and ipsilateral cutaneous digital nerve stimulation on motor evoked potentials (MEPs) elicited in hand muscles by transcranial magnetic stimulation (TMS). We tested the effect of different magnetic stimulus intensities on MEPs recorded from the thenar eminence (TE) muscles of the right hand while an electrical conditioning stimulus was delivered to the second finger of the same hand with an intensity four times above the sensory threshold. Amplitude decrement of conditioned MEPs as a function of magnetic stimulus intensity was observed. The lowest TMS stimulus intensity produced the largest decrease in conditioned MEPs. Moreover, we investigated the effects of ipsilateral and contralateral electrical digital stimulation on MEPs elicited in the right TE and biceps muscle using an intensity 10% above the threshold. Marked MEP inhibition in TE muscles following both ipsilateral and contralateral digital stimulation is the main finding of this study. The decrease in conditioned MEP amplitude to ipsilateral stimulation reached a level of 50% of unconditioned MEP amplitude with the circular coil and 30% with the focal coil. The amplitude of conditioned MEPs to contralateral digital stimulation showed a decrease of 60% with the circular coil and more than 50% with the focal coil. The onset of the inhibitory effect of contralateral stimulation using the focal coil occurred at a mean of 15 ms later than that of ipsilateral stimulation. No MEP inhibition was observed when recording from proximal muscles. Ipsilateral and contralateral digital stimulation had no effect on F wave at appropriate interstimulus intervals, where the main MEP suppression was noted. We stress the importance of selecting an appropriate test stimulus intensity to evaluate MEP inhibition by digital nerves stimulation. Spinal and cortical sites of sensorimotor integration are adduced to explain the direct and crossed MEP inhibition following digital nerves stimulation.

Direct and indirect corticospinal control of arm and hand motoneurons in the squirrel monkey (Saimiri sciureus)

Anatomic evidence suggests that direct corticomotoneuronal (CM) projections to hand motoneurons in the New World squirrel monkey (Saimiri sciureus) are weak or absent, but electrophysiological evidence is lacking. The nature of the corticospinal linkage to these motoneurons was therefore investigated first with the use of transcranial magnetic stimulation (TMS) of the motor cortex under ketamine sedation in five monkeys. TMS produced early responses in hand muscle electromyogram, but thresholds were high (compared with macaque monkey) and the onset latency was variable. Second, stimulation of the pyramidal tract (PT) was carried out with the use of chronically implanted electrodes in ketamine-sedated monkeys; this produced more robust responses that were markedly facilitated by repetitive stimulation, with little decrease in latency on the third compared with the first shock. Finally, postsynaptic potentials were recorded intracellularly from 93 arm and hand motoneurons in five monkeys under general chloralose anesthesia. After a single PT stimulus, the most common response was a small, slowly rising excitatory postsynaptic potential (EPSP), either alone (35 of 93 motoneurons) or followed by an inhibitory postsynaptic potential (39 of 93). The segmental delay of the early EPSPs was within the monosynaptic range (mean 0.85 ms); however, the rise time of these EPSPs was slow (mean 1.3 ms) and their amplitude was small (mean 0.74 mV). These values are significantly slower and smaller than EPSPs in a comparable sample of Old World macaque monkey motoneurons. The results show that CM connections do exist in the squirrel monkey but that they are weak and possibly located on the remote dendrites of the motoneurons. The findings are consistent with earlier anatomic studies. Repetitive PT stimulation produced large, late EPSPs in some motoneurons, suggesting that, in this species, there are relatively strong nonmonosynaptic pathways linking the corticospinal tract to hand motoneurons.

Techniques and mechanisms of action of transcranial stimulation of the human motor cortex

Electrical and magnetic methods are available to stimulate the human brain through the intact scalp. Although both are successful, magnetic stimulation is now used almost exclusively because the discomfort is minimal compared with that caused by electrical stimulation. Nevertheless, electrical stimulation is still used occasionally since comparison of results from both techniques can often yield useful clinical and scientific information not available from either method in isolation.

Neurophysiological methods for studies of the motor system in freely moving human subjects

In this paper, the following experimental methods for studies of the motor system in freely moving human subjects will be considered: (i) eliciting the H-reflex and understanding its use as a test response, (ii) methods to measure reciprocal inhibition between antagonist muscles, (iii) methods to measure presynaptic inhibition of Ia-afferent terminals in the spinal cord, (iv) certain aspects of the interpretation of peri-stimulus time histograms (PSTH) of single motor unit discharge, and finally, (v) stimulation of the motor cortex and the measurement of response parameters that may reflect task dependent changes. Two closely related ideas bearing directly on these methods will be emphasized--the influence of the background level of motor activity on input output properties of the neural pathway investigated and the operating point on the input-output curves at which the experimental variable is measured. Finally, in the discussion a simple model that is easily understandable in geometric terms is presented to help predict and interpret the outcome of these sorts of experiments.

Evidence suggesting a transcortical pathway from cutaneous foot afferents to tibialis anterior motoneurones in man

1. Stimulation of the superficial peroneal or the sural nerve (3 shocks, 3 ms interval, 1 ms duration, 2.5 x perception threshold) evoked a reflex activation of the tibialis anterior muscle at a latency of approximately 70-95 ms in all of nine healthy human subjects. Stimulation of the medial plantar nerve only rarely produced similar effects. The possibility that a transcortical pathway contributes to these late reflex responses was investigated by combining the cutaneous stimulations and a transcranial magnetic stimulation of the contralateral motor cortex. 2. A significant facilitation of short-latency peaks in the post-stimulus time histogram of single tibialis anterior motor units evoked by the transcortical magnetic stimulation was observed in eight out of nine subjects following stimulation of the superficial peroneal or sural nerves at the latency of the long-latency reflex. In contrast such a facilitation was only rarely seen when the medial plantar nerve was stimulated. 3. With the same timing for the stimuli, the superficial peroneal and sural nerve stimulations also produced a significant increase in the short-latency, presumed monosynaptic, facilitation of the tibialis anterior H reflex produced by the brain stimulation. 4. Similar facilitatory effects of the cutaneous stimuli could not be demonstrated when the magnetic stimulation of the cortex was replaced with electrical stimulation, implying that cortical excitability is affected by a conditioning cutaneous stimulation. 5. It is suggested that the long-latency reflexes in the tibialis anterior muscle evoked by activation of cutaneous afferents from the human foot are, at least partly, mediated by a transcortical pathway.

Motor cortex involvement during choice reaction time: a transcranial magnetic stimulation study in man

It has been shown that transcranial magnetic stimulation can delay simple reaction time; this happens when the stimulation is delivered during the reaction time and over the cortical area which commands the prime mover of the required response. Although it is agreed that magnetic stimulation could be a useful tool for studying information processing in man, we argue that, because of the use of simple reaction time, the results reported so far are difficult to interpret within this theoretical framework. In the present paper, three experiments are reported. Six subjects participated in experiment 1 in which magnetic stimulation was delivered, at different times, during choice reaction time. The effects of the magnetic stimulation of the cortical area involved in the response (induced current passing forward over the motor representation of the responding hand), were compared to the effects of an electrical stimulation of the median nerve (H-reflex). In a first control experiment (experiment 2a; 5 subjects), the coil was placed over the ipsilateral motor cortex (induced current passing backward over the motor representation of the non-responding hand) thus minimizing the probability to excite the same neural nets as in the first experiment. In a second control experiment (experiment 2b; 4 subjects), the coil was placed a few centimeters away from the subject's scalp thus ensuring no stimulation of any neural nets. The results show that: (1) the noise and the smarting of the skin associated with the coil discharge produce an intersensory facilitation thereby shortening reaction time (experiment 2a), (2) actually, the noise produced by the stimulation is sufficient to produce such a facilitatory effect (experiment 2b), (3) a stimulation over the area at the origin of the motor command causes a reaction time delay which counteracts this intersensory facilitation effect (experiment 1), (4) in this latter case, the closer the stimulation to the actual overt response, the longer the delay and (5) there is no trace of correlation between the amplitude of the motor evoked potential and the reaction time change.

Transcranial magnetic stimulation as a prognostic tool in stroke

Our aims were to evaluate the prognostic usefulness of magnetic motor evoked potentials (MMEPs) in ischemic stroke, to study the evolution of MMEP abnormalities and the relationships between MMEP abnormalities and infarction topography. We prospectively analyzed 50 consecutive ischemic stroke patients who were followed up to 1 year. MMEPs were recorded 1, 3, 30 and 90 days after stroke and we measured amplitudes and latencies/central motor conduction times (CMCTs) of MMEPs from hypothenar, biceps brachiallis, gastrocnemius and quadriceps. Univariate and multivariate analyses of the clinical and MMEPs data were performed. Patients with Rankin 0-3 at 1 year had had acutely MMEPs with shorter latencies and higher amplitudes than patients with Rankin 4-5 or deceased patients. Increased blood pressure correlated with increased survival, whereas increased heart rate and hyperglycemia correlated with increased mortality. The variables infarction size on second CT, age, and first day CMCT-S1 correctly classified 1 year outcome on discriminant analysis. The inclusion of MMEPs values increased the probability of correct classification from 76% to 84%. We conclude that in patients with nondisabling strokes MMEPs may have an independent value in the prediction of prognosis, increasing the accuracy of prognosis calculations made employing clinical and laboratory data. Topography of lesions should be considered when analyzing MMEP abnormalities after stroke.

An electrophysiological study of the postnatal development of the corticospinal system in the macaque monkey

Postnatal development of the corticospinal system was investigated in 13 macaques using noninvasive transcranial magnetic stimulation (TMS) of the motor cortex and direct electrical stimulation of corticospinal axons in the medullary pyramid and spinal cord. The latency of antidromic corticospinal volleys evoked from the pyramid and recorded from the motor cortex decreased dramatically during the first postnatal months. Our data predict that conduction velocity (CV) of the fastest corticospinal neurons over their cranial course would reach adult values at approximately 11 months. The CV of corticospinal neurons in the spinal cord increased with age but with a slower time course. In the neonate, the fastest spinal CV was estimated at 7.8 m/sec, approximately 10 times slower than in adults (mean 80.0 m/sec). Our data predict that full myelination of corticospinal axons in the spinal cord would not occur until approximately 36 months. No short-latency EMG responses were elicited in arm and hand muscles by TMS until 3 months of age; TMS thresholds were high initially and then fell progressively with age. When corrected for body size, relative latencies of EMG responses showed an exponential decrease during the first postnatal months. Our data are consistent with the hypothesis that fine finger movements are not observed before functional CM connections are well established and that rapid changes in the physiological properties of the corticospinal system coincide with the period in which precision grip is known to mature (3-6 months). However, corticospinal development continues long after simple measures of dexterity indicate functional maturity, and these changes may contribute to the improved speed and coordination of skilled hand tasks.

An electrophysiological study of the postnatal development of the corticospinal system in the macaque monkey

Postnatal development of the corticospinal system was investigated in 13 macaques using noninvasive transcranial magnetic stimulation (TMS) of the motor cortex and direct electrical stimulation of corticospinal axons in the medullary pyramid and spinal cord. The latency of antidromic corticospinal volleys evoked from the pyramid and recorded from the motor cortex decreased dramatically during the first postnatal months. Our data predict that conduction velocity (CV) of the fastest corticospinal neurons over their cranial course would reach adult values at approximately 11 months. The CV of corticospinal neurons in the spinal cord increased with age but with a slower time course. In the neonate, the fastest spinal CV was estimated at 7.8 m/sec, approximately 10 times slower than in adults (mean 80.0 m/sec). Our data predict that full myelination of corticospinal axons in the spinal cord would not occur until approximately 36 months. No short-latency EMG responses were elicited in arm and hand muscles by TMS until 3 months of age; TMS thresholds were high initially and then fell progressively with age. When corrected for body size, relative latencies of EMG responses showed an exponential decrease during the first postnatal months. Our data are consistent with the hypothesis that fine finger movements are not observed before functional CM connections are well established and that rapid changes in the physiological properties of the corticospinal system coincide with the period in which precision grip is known to mature (3-6 months). However, corticospinal development continues long after simple measures of dexterity indicate functional maturity, and these changes may contribute to the improved speed and coordination of skilled hand tasks.

Transcallosal inhibition in cortical and subcortical cerebral vascular lesions

The excitability of the motor cortex after transcranial magnetic stimulation was investigated in 10 patients with purely subcortical, and in 22 patients with cortical-subcortical cerebrovascular lesions. In the first investigation we applied magnetic double stimuli over both motor cortices with different inter-stimulus intervals. The first (conditioning) stimulus was applied to the affected hemisphere and the second stimulus (test stimulus) to the unaffected side. The responses of the first dorsal interosseal (FDI) muscle, contralateral to the test stimulus, were recorded after applying the test stimulus alone and at inter-stimulus intervals of 5 ms, 7 ms, 15 ms, 30 ms and 60 ms. In a second investigation the patients were asked to activate their non-paretic first dorsal interosseus muscle and the magnetic stimulus was applied over the affected hemisphere. The EMG responses were rectified and averaged. Patients with subcortical cerebral lesions below the centrum semiovale (i.e., having no effect on the transcallosal fibres) displayed a pronounced inhibition of one motor cortex after the stimulation of the contralateral side, comparable with normal subjects. Patients with cortical-subcortical cerebral lesions displayed only partly less inhibition of their motor cortex but the results in this group were not uniform. Since inhibition was preserved in patients with subcortical lesions, which had destroyed the corticospinal tract, we conclude that this inhibition is not mediated through an ipsilateral projection but via a transcallosal route.

Transcallosally mediated inhibition of interneurons within human primary motor cortex

The objective of this study was to investigate interhemispheric transcallosal connections between primary motor cortices noninvasively in awake human subjects. For this purpose, focal transcranial magnetic stimulation was performed on eight healthy, right-handed subjects and one patient with congenital collosal agenesis. Using two magnetic stimulators, we investigated the effect of a conditioning magnetic stimulus applied to the motor cortex of one hemisphere on the duration of the silent period (SP) evoked in the first dorsal interosseus (FDI) muscle by a magnetic test stimulus given over the opposite motor cortex. It is well established that SP reflects activation of inhibitory interneurons within primary motor cortex. In all normal subjects, a conditioning stimulus to one hemisphere produced a significant shortening of SP evoked by the test stimulus when the conditioning-test-interval was 10-20 ms. The effect was also observed when an electrical test stimulus was used. The conditioning coil had to be placed over the hand motor area to obtain the maximal effect. The threshold for eliciting this decrease of SP duration was higher than the threshold for eliciting an early excitatory muscle response in the contralateral FDI. Increasing the intensity of the conditioning stimulus led to linear reduction of SP duration. In the patient with callosal agenesis, no such decreasing effect on SP duration was observed. These results suggest that inhibitory interneurons within primary hand motor cortex receive transcallosal inhibitory input from the opposite motor cortex. We propose that modulation of motor cortical interneurons via transcallosal pathways may provide a gain control for the motor cortical output system and subserve interhemispheric coordination in complex, nonsymmetrical bimanual movements.

An investigation of motor function in schizophrenia using transcranial magnetic stimulation of the motor cortex

BACKGROUND

In this first investigation of motor function in schizophrenia using transcranial magnetic stimulation (TMS), the general hypothesis tested was that this methodology could be used to investigate the disruption of corticospinal inhibitory processes suggested by cognitive and psychophysiological paradigms.

METHOD

Nine drug-free DSM-IV schizophrenic patients were compared with nine age- and sex-matched normal subjects. Electromyographic (EMG) recordings were made from the thenar muscles of the dominant hand during sustained, weak voluntary contraction. TMS over a particular threshold applied to the motor cortex would elicit a compound motor evoked potential (cMEP) followed by a period of suppression of EMG.

RESULTS

The latency of cMEPs following TMS was significantly shorter in the schizophrenic patients. The two groups did not differ significantly with respect to mean latency of suppression of EMG activity, or stimulus thresholds for either cMEPs or EMG suppression.

CONCLUSION

These findings could be the result of a relative lack of corticospinal inhibition of motor responses; a change in the site of TMS activation; or an abnormality of peripheral nervous function in schizophrenia. Drug effects were unlikely since seven of the patients were drug-naive.

Central fatigue assessed by transcranial magnetic stimulation

Central fatigue is a subjective phenomenon which can be examined using transcranial magnetic stimulation (TMS). To assess central fatigue, we compared TMS and peripheral electrical stimulations in patients with central nervous system (CNS) lesions and controls before and after an exhaustive task. The recovery times of motor evoked potential (MEP) amplitudes were significantly prolonged in the patient group whereas the recovery of F waves and compound muscle action potentials showed no significant changes. The results indicate that fatigue cannot be attributed either to intramuscular processes or to reduced spinal excitability, but reflects a supraspinal, probably cortical phenomenon. The measurement of MEP recovery times proved to be a simple and objective tool for the assessment of fatigue and for the differentiation between healthy controls and patients with CNS lesions.

Site of facilitation of diaphragm EMG to corticospinal stimulation during inspiration

The electromyographic response of the diaphragm to (a) transcutaneous electrical stimulation (TCES) of the spinal cord at C5 and above, (b) transcranial magnetic stimulation (TMS) over the motor cortex and (c) transcutaneous electrical stimulation of the phrenic nerve in the neck (TPNS), was recorded in six normal subjects at the antero-lateral chest wall. The compound motor evoked potentials (cMEPs) recorded in response to both TMS and TCES were facilitated to a similar extent during volitional inspiration; this facilitation was greater than any change seen in response to TPNS with inspiration. The results show that facilitation of the response in the diaphragm to TMS during volitional inspiration is due to increased excitability at synapses associated with the spinal motoneurone pool, but they do not exclude a component due to increased higher centre excitability. We conclude that it is unsafe to assign a cortical contribution to 'automatic' inspiration on the sole basis of facilitation of the electromyographic response in the diaphragm to TMS.

Insights into motor performance and muscle fatigue based on transcranial stimulation of the human motor cortex

1. Direct cortical stimulation of motor and sensory areas of the cortex in experimental animals and some neurosurgical patients has provided much useful physiological information. Some of the benefits of this approach can be provided in awake volunteer subjects using new techniques which activate the motor cortex thorough the skull (i.e. transcranial electrical or magnetic stimulation). 2. Both electrical and magnetic transcranial stimulation produce complex descending corticospinal volleys which usually contain a direct component (via corticofugal axons) and an indirect trans-synaptic component. Changes in cortical 'excitability' can affect the evoked corticofugal volleys and the electromyographic responses which they involve. 3. Apart from its diagnostic applications to patients with neurological disorders, transcranial stimulation has been applied to the study of a range of aspects of human motor control ranging from apparent cortical 'plasticity' to the changes in cortical behaviour produced by exercise.

Contralateral and ipsilateral EMG responses to transcranial magnetic stimulation during recovery of arm and hand function after stroke

We examined the relationship between the recovery of hand and arm function in a group of hemiplegic stroke patients and the presence of short-latency EMG responses to transcranial magnetic stimulation (TMS) in 4 different upper limb muscles (deltoid, biceps, extensor digitorum communis and the first dorsal interosseous). Twenty-one patients were examined within 5 weeks of stroke (median 2 weeks), and then at regular intervals over the next 12 months. Some patients recovered rapidly (Group A); in others, recovery was slow and incomplete (Group B). Even at the first test, Group A patients had responses to TMS in all muscles. Most Group B patients initially lacked responses in all tested upper limb muscles; in those that later were able to activate hand muscles, responses returned at or just before this stage of recovery. No such clear correlation between the presence of responses to TMS and ability to activate more proximal arm muscles was evident. Response latency was initially long and declined in a manner that was highly correlated with muscle strength and hand function test scores. Ipsilateral responses were elicited from both the affected and unaffected hemispheres. Ipsilateral responses from the latter were most common in the proximal muscles of the affected limb, and had latencies that were longer than those elicited in the contralateral (unaffected) arm. Nine cases of ipsilateral responses in hand muscles were found; such responses are not found in healthy subjects. Ipsilateral responses from the undamaged hemisphere were more prevalent in the poorly recovered patients; the underlying mechanisms may not be beneficial for recovery.

Conditioning lower limb H-reflexes by transcranial magnetic stimulation of motor cortex reveals preserved innervation in SCI patients

Conditioning of lower limb H-reflexes by transcranial magnetic stimulation of motor cortex was used to detect preserved innervation in patients with long-standing spinal cord injury (SCI). Cortical stimulation was delivered at intensities suprathreshold or subthreshold for evoking motor evoked potentials (MEPs). The conditioning (C) cortical stimulation preceded the test (T) H-reflex stimulus at intervals between C-T: 10-300 msec. Conditioned H-reflex profiles in control subjects (n = 10), following both suprathreshold and subthreshold cortical conditioning, yielded evidence of early (C-T: 10-30 msec) and late arriving (C-T: 60-130 msec) excitatory inputs to the lateral gastrocnemius (LG) motoneuron pool. Demonstration of late inputs following subthreshold cortical conditioning suggested the inputs are mediated by slow conducting or oligosynaptic descending motor tracts, as distinct from afferent consequences of short latency MEPs. In SCI patients (n = 11) the conditioned H-reflex profile varied according to the patients' ASIA impairment rating. Higher functioning SCI patients (ASIA level C and D) revealed evidence of both early and late arriving inputs to the lumbosacral motoneuron pool whereas patients with more severe impairments (ASIA levels A and B) most often failed to exhibit early or late periods of H-reflex facilitation in LG. In three patients (i.e., 1 ASIA B; 2 ASIA C) the cortical modulation of H-reflex amplitudes yielded evidence of preserved corticospinal innervation that was not detectable by other MEP reinforcement procedures. These results introduce the cortical conditioning procedure as a sensitive means of detecting latent corticospinal and/or bulbospinal innervation in SCI patients consistent with the emerging neuropathological picture of preserved axonal integrity in descending motor tracts in the face of extensive functional loss.

Spatial differences in the sites of direct and indirect activation of corticospinal neurones by magnetic stimulation

Transcranial magnetic stimulation (TMS) over the human motor cortex evokes multiple descending volleys possibly through activation of different elements within the brain. We have investigated whether such elements can be distinguished spatially. Using a figure of eight coil, TMS was delivered over multiple scalp sites during a low level voluntary contraction of the left first dorsal interosseous muscle. At near-threshold intensity, early or late surface electromyograph (EMG) components (relative to anodal response latency) could be preferentially evoked with the coil aligned in a medio-lateral (ML), antero-posterior (AP), or postero-anterior (PA) orientation. The optimal location of the earliest component with ML coil orientation was 8 mm medial and 5 mm anterior compared to a later component with AP orientation. The optimal location for the same latency EMG component mapped using two different coil orientations (AP and ML) was not significantly different. The optimal location of two different late components, one obtained with AP and the other with PA coil orientations, was similar. It is argued that the earliest TMS-evoked component results from direct activation of corticospinal cell axons while later components result from activation of these cells trans-synaptically (indirectly), and that consequently there is a substantial spatial separation between these activation sites.

Direct and indirect activation of human corticospinal neurons by transcranial magnetic and electrical stimulation

Corticospinal volleys and surface electromyographic (EMG) responses evoked by magnetic and electrical transcranial stimulation were recorded simultaneously in three conscious human subjects. For magnetic stimulation, the figure-of-eight coil was held on the hand motor area either with the induced current through the brain flowing in a postero-anterior direction (P-A stimulation) or in a latero-medial direction (L-M stimulation). For electrical stimulation, the anode was placed 7 cm lateral to the vertex and cathode at the vertex (anodal stimulation). The P-A stimulation that was generally used preferentially evoked I waves, whereas the L-M and anodal stimulation preferentially evoked D wave. The results suggested that the mode of activation by transcranial magnetic stimulation altered, depending on its current direction, and the difference between P-M magnetic and electrical stimulation can be explained by the context of the D and I hypothesis.

The effect of lorazepam on the motor cortical excitability in man

The effect of the short-acting benzodiazepine lorazepam on motor cortex excitability was investigated in 11 healthy volunteers using the technique of focal transcranial magnetic stimulation. The threshold intensity for evoking an electromyographic response in the resting and active abductor digiti minimi muscle, the size of the motor evoked potential, the duration of the cortical and peripheral silent periods, the corticocortical inhibition and facilitation after paired magnetic stimuli, and the transcallosal inhibition were used as parameters to assess various aspects of motor system excitability. Baseline values were compared with data obtained 2, 5 and 24 h after a single oral dose of 2.5 mg lorazepam. Resting and active motor thresholds and the size of the motor evoked potential remained unchanged. The duration of the cortical silent period was prolonged with a maximum effect 5 h after drug intake, while the peripheral silent period did not show any lengthening at that time. The corticocortical inhibition showed a tendency toward more inhibition, while the corticocortical facilitation was almost completely suppressed. The transcallosal inhibition showed an inconsistent trend to less inhibition. In parallel to the pharmacokinetics of lorazepam, all effects peaked at 2 h and 5 h, and were (partially) reversible after 24 h. It is hypothesized that most of these findings are due to the reinforcement of GABA action by lorazepam at the level of the motor cortex. The lack of effect on motor threshold and on the size of the motor evoked potential may indicate that these parameters are physiologically distinct from corticocortical excitability and the cortical silent period. The relevance of the present data in clinical epileptology is discussed.

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.

The contribution of transcortical pathways to long-latency stretch and tactile reflexes in human hand muscles

Long-latency electromyographic (EMG) responses can be evoked in the first dorsal interosseous muscle (FDI) by unexpected slips of an object (skin stretch) held between the index and thumb, or by forcible adduction of the metacarpophalangeal joint (muscle stretch). The former type of response is due to stimulation of tactile afferents in the skin of the digits, whereas the latter also activates muscle receptors. Previous studies have provided good evidence that long-latency reflex responses to stretch of distal muscles involve activity in a transcortical reflex pathway. The present experiments examined whether cutaneous reflexes also utilise a transcortical route. Transcranial magnetic or electrical stimuli were given over the motor cortex to evoke EMG activity during the period of the long-latency reflex response. When evoked by muscle stretch the responses to magnetic stimulation were facilitated more than those to electric stimulation. In contrast, facilitation was equal during the long-latency reflex elicited by cutaneous stimulation. Because of the different ways in which electrical and magnetic stimuli are believed to activate the motor cortex, we interpret these results to mean that the long-latency response to skin stretch is not mediated by a transcortical mechanism in the majority of subjects, whereas that following muscle stretch is. However, these are average data. In a few individual subjects, the opposite results were obtained. We suggest that there may be differences between subjects in the transcortical contribution to long-latency reflex responses. The implication is that, under normal circumstances, several pathways may contribute to these responses. If so, the relative roles of the pathways may change during different tasks, and in pathological states lesions in one system may well be accompanied by compensatory changes in other systems.

Corticospinal direct response to transcranial magnetic stimulation in humans

The corticospinal motor evoked potential (MEP) response to transcranial magnetic stimulation of the motor cortex was investigated in comparison with the direct (D) response to electrical stimulation of the exposed motor cortex from the spinal epidural space in 7 neurologically normal patients during brain tumor surgery. The D response during operation was obtained by transcranial magnetic stimulation of the scalp over the areas of the cerebral motor cortex, the hand or arm areas. The magnetic induced D response showed a conduction velocity of 50.5-72.7 m/sec and was resistant to anesthesia and unaffected by muscle relaxants and tolerant to high frequency (500 Hz) paired magnetic stimulus, and the latencies of magnetic MEPs corresponded to those with direct electrical stimulation. Thus, recordings of the D response by transcranial magnetic stimulation are useful for not only identifying the location of the motor cortex during intracranial surgery but also for non-invasive recording of pyramidal tract activity during extracranial surgery under general anesthesia.

Supraspinal factors in human muscle fatigue: evidence for suboptimal output from the motor cortex

1. Voluntary activation of elbow flexor muscles can be optimal during brief maximal voluntary contractions (MVCs), although central fatigue, a progressive decline in the ability to drive the muscle maximally, develops during sustained or repeated efforts. We stimulated the motor cortex and motor point in human subjects to investigate motor output during fatigue. 2. The increment in force (relative to the voluntary force) produced by stimulation of the motor point of biceps brachii increased during sustained isometric MVCs of the elbow flexors. Motoneuronal output became suboptimal during the contraction, i.e. central fatigue developed and accounted for a small but significant loss of maximal voluntary force. During 3 min MVCs, voluntary activation of biceps fell to an average of 90.7% from an average of > 99%. 3. The increment in force (relative to the voluntary force) produced by magnetic cortical stimulation was initially small (1.0%) but also increased during sustained MVCs to 9.8% (with a 2 min MVC). Thus, cortical output was not optimal at the time of stimulation nor were sites distal to the motor cortex already acting maximally. 4. A sphygmomanometer cuff around the upper arm blocked blood supply to brachioradialis near the end of a sustained MVC and throughout subsequent brief MVCs. Neither maximal voluntary force nor voluntary activation recovered during ischaemia after the sustained MVC. However, fatigue-induced changes in EMG responses to magnetic cortical stimulation recovered rapidly despite maintained ischaemia. 5. In conclusion, during sustained MVCs, voluntary activation becomes less than optimal so that force can be increased by stimulation of the motor cortex or the motor nerve. Complex changes in excitability of the motor cortex also occur with fatigue, but can be dissociated from the impairment of voluntary activation. We argue that inadequate neural drive effectively 'upstream' of the motor cortex must be one site involved in the genesis of central fatigue.

Changes in motor cortical excitability during human muscle fatigue

1. The excitability of the motor cortex was investigated during fatiguing con of the elbow flexors in human subjects. During sustained contractions at 30 and 1 voluntary force (MVC), the short-latency electromyographic responses (EMG) evoke brachii and brachioradialis by transcranial magnetic stimulation increased in si EMG in the elbow flexors following the evoked muscle potential (silent period), duration during a sustained MVC but not during 30% MVCs nor during a sustained M muscle (adductor pollicis). 2. When the blood supply to brachioradialis was blocked with sphygmomanometer cuff sustained MVC, the changes in EMG responses to transcranial stimulation rapidly control values, This suggests that changes in these responses during fatigue wer small-diameter muscle afferents. 3. Tendon vibration during sustained MVCs indicated that the changes in the resp cortial stimulation were not mediated by reduced muscle spindle inputs. 4. Muscle action potentials evoked in brachioradialis by electrical stimulation cervicomedullary junction did not increase in size during sustained MVCs. Thus, cortically evoked responses during sustained MVCs reflects a change in cortical Although the silent period following cervicomedullary stimulation lengthened, it substantially shorter than the cortically evoked silent period. 5. The altered EMG responses to transcranial stimulation during fatigue suggest exitation and increased inhibition in the motor cortex. As these changes were un manipulation of afferent input they presumably result from intrinsic cortical pr altered voluntary drive to the motor cortex.

Changes of inhibitory interneurons during transcallosal stimulations

The present study was performed in order to determine the influence of ipsilateral transcranial magnetic stimulations (TMS) on the silent period evoked by contralateral cortical stimulations. Ipsilateral TMS preceded the contralateral magnetic or electrical cortex stimulation by 0-50 ms. In all subjects, the duration of the silent period was decreased in interstimulus intervals of 20-30 ms when using magnetic ipsi- and contralateral stimuli. No change in the silent period was seen with ipsilateral magnetic and contralateral electrical stimulations. Decreases of motor evoked potential amplitudes were an inconsistent phenomenon. The results indicate that ipsilateral TMS in activate inhibitory cortical interneurons, probably via transcallosal pathways. Different time courses and different degrees of inhibition indicate that motor excitation and inhibition may be mediated by different neuronal circuits.

Afferent excitation of human motor cortex as revealed by enhancement of direct cortico-spinal actions on motoneurones

Changes in motor cortex excitability induced by somatosensory afferences were evaluated in 5 subjects by testing how the short-latency cortico-spinal effects evoked by transcranial magnetic stimulation in flexor carpi radialis (FCR) motoneurones were influenced by volleys in median nerve afferent fibres. Transcranial magnetic stimulation induced two facilitatory peaks on FCR H reflex, the first at a conditioning-test interval of about -3 msec and the second at msec, separated by a phase of inhibition. If an electric shock to the median nerve at the wrist, 0.8-1 x motor threshold (MT) for thenar muscles, preceded the cortical stimulus by 18-25 msec, an increase in size of both facilitatory peaks was observed. The increase was partly due to a direct action of the median nerve volley on motoneurones. When this contribution was subtracted, two peaks of additional facilitation resulted as the effect of combined conditioning. Additional facilitation was present even during the short-lasting phase ascribed to monosynaptic cortico-spinal excitation of motoneurones, i.e., the first millisecond of the earliest facilitatory peak. This result indicates that cortical responsiveness to magnetic stimulation had been enhanced by the peripheral stimulus. The time course of the excitability changes in motor cortex was compared with the cortical somatosensory evoked potentials (SEPs) induced by the same peripheral stimulus. Additional facilitation was present immediately after the N20 peak of SEPs and lasted 8-10 msec. Additional facilitation had the same threshold as N20 (0.6 x MT) and grew in parallel with it when grading the afferent stimulus up to 1 MT.

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.

The effect of transcranial magnetic stimulation of rat brain on behavioral models of depression

Magnetic stimulation of the brain in unanesthetized humans and animals can painlessly induce motor movements and has recently been reported to have antidepressant properties. In behavioral models of depression and electroconvulsive therapy including enhancement of apormorphine-induced stereotypy, reduction of immobility in the Porsolt swim test and increases in seizure threshold for subsequent stimulation, magnetic stimulation of rat brain had effects similar to those of electroconvulsive shock.

Task-related variation in corticospinal output evoked by transcranial magnetic stimulation in the macaque monkey

1. A volley evoked by transcranial magnetic stimulation (TMS) over the motor cortex was recorded from the medullary pyramid in an awake monkey performing a precision grip task. It was identified as corticospinal using a collision test. 2. The volley latency was 0.50 ms, indicating that it was produced by direct activation of corticospinal neurones. 3. A mean modulation of 13% in the amplitude of this volley was seen during task performance, with the largest volley occurring during the hold phase of the task. A similar pattern of modulation was seen in the EMG responses of hand and forearm muscles to TMS. 4. No comparable modulation was observed in a volley evoked by electrical stimulation of the corticospinal fibres via chronically implanted electrodes in the cerebral peduncle. 5. The results are compatible with direct activation of the corticospinal neurones by TMS at a site close to the soma, with the probability of activation by TMS depending on the current level of cortical excitability.

Responses of human motoneurons to Ia inputs: effects of background firing rate

The effects of synchronous Ia volleys on the firing probability of repetitively firing human motoneurons were examined at fast and slow firing rates. Ia afferents of either the median or the posterior tibial nerve were stimulated, while single motor unit activity was recorded from the homonymous muscles. Motoneuron responses to the Ia inputs were quantified by measurement of the magnitude of the short latency excitatory peak in peristimulus time histograms (PSTHs). When the stimuli were given at random with respect to the times of motor unit spikes, the magnitude of the PSTH peak (response probability) was significantly lower at a faster firing rate. In the "triggered" mode of stimulation, stimuli were given at various known times during the interspike interval. In this mode the response probability to the input increased monotonically as the stimuli were delivered progressively later during the interspike interval. The response probability at a fixed delay with respect to the triggering spike was higher at the faster firing rate. The results obtained with the two modes of stimulation are not in contradiction and both may be explained by the nature of membrane voltage trajectories and ionic conductances during the interspike interval described for repetitively firing cat motoneurons.

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.

Focal depression of cortical excitability induced by fatiguing muscle contraction: a transcranial magnetic stimulation study

Motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES) of the motor cortex were recorded in separate sessions to assess changes in motor cortex excitability after a fatiguing isometric maximal voluntary contraction (MVC) of the right ankle dorsal flexor muscles. Five healthy male subjects, aged 37.4 +/- 4.2 years (mean +/- SE), were seated in a chair equipped with a load cell to measure dorsiflexion force. TMS or TES was delivered over the scalp vertex before and after a fatiguing MVC, which was maintained until force decreased by 50%. MEPs were recorded by surface electrodes placed over quadriceps, hamstrings, tibialis anterior (TA), and soleus muscles bilaterally. M-waves were elicited from the exercised TA by supramaximal electrical stimulation of the peroneal nerve. H-reflex and MVC recovery after fatiguing, sustained MVC were also studied independently in additional sessions. TMS-induced MEPs were significantly reduced for 20 min following MVC, but only in the exercised TA muscle. Comparing TMS and TES mean MEP amplitudes, we found that, over the first 5 min following the fatiguing MVC, they were decreased by about 55% for each. M-wave responses were unchanged. H-reflex amplitude and MVC force recovered within the 1st min following the fatiguing MVC. When neuromuscular fatigue was induced by tetanic motor point stimulation of the TA, TMS-induced MEP amplitudes remained unchanged. These findings suggest that the observed decrease in MEP amplitude represents a focal reduction of cortical excitability following a fatiguing motor task and may be caused by intracortical and/or subcortical inhibitory mechanisms.

The relation between bradykinesia and excitability of the motor cortex assessed using transcranial magnetic stimulation in normal and parkinsonian subjects

The response of single motor units in the first dorsal interosseus (FDI) muscle to transcranial magnetic stimulation (TMS) of the motor cortex has been assessed using the post-stimulus time histogram during weak voluntary contraction in patients with parkinsonian symptoms and in age-matched, normal subjects. Patients and subjects were required to maintain the discharge of a motor unit at a steady rate during TMS. Responses were evident in post-stimulus time histograms of motor unit discharges as single or double peaks at mean (+/- S.E.) latencies of 23.4 msec (+/- 0.7) for normal subjects and 24.9 msec (+/- 0.9) for parkinsonian patients. There were no significant differences in latency or tendency to double peaks in the responses of motor units when normal subjects and parkinsonian patients were compared. The group data showed no significant difference between the threshold TMS for modulation of the discharge of single motor units in patients and normal subjects. However, 7 of the 15 parkinsonian patients, but only 1 of 15 normal subjects, had thresholds to TMS greater than or equal to 45% of the maximum output of the magnetic stimulator. Speed of movement was measured by 3 tasks: (1) timed stand/walk/sit, (2) timed peg-board test, (3) frequency of 2-point table taps. In the parkinsonian group there was a positive linear correlation between threshold to TMS and degree of bradykinesia for each individual score and the average score on the tests of speed of movement. This was not evident for the normal group. The results are discussed in the light of current views on the mode of action of TMS. The findings are consistent with the conclusion that parkinsonian patients exhibiting pronounced bradykinesia have a lowered excitability of the motor cortex.

Excitability of human upper limb motoneurones during rhythmic discharge tested with transcranial magnetic stimulation

1. The activity of thirty-one single motor units (SMUs) was recorded from forearm and hand muscles of three volunteers. The excitability of the rhythmically firing motoneurones supplying these SMUs was examined after voluntary discharge using transcranial magnetic stimulation (TMS). 2. The magnetic stimulus was delivered either at a fixed delay (range: 1-60 ms) after SMU discharge (triggered mode) or at random with respect to voluntary SMU discharge (random mode). Post-stimulus time histograms (PSTHs) of responses to 50-100 stimuli were constructed for each experimental condition. 3. In the triggered mode, the probability of response to TMS progressively decreased as the spike-to-stimulus interval was shortened. Shortening of the interval also resulted in redistribution of responses within the different subpeaks characterizing the short-latency response of motor units to TMS: the relative response probability of the first subpeak decreased with the shorter spike-to-stimulus intervals. 4. In the triggered mode, the probability of SMU responding to TMS was significantly higher when the firing rate of the motor unit was increased from a slow rate (< 10 impulses s-1) to a faster rate (> 12 impulses s-1), irrespective of the spike-to-stimulus interval. In contrast, in the random mode, the response probability was greater at the slower discharge rate. 5. The higher excitability of motoneurones at the fast rate in the triggered mode is consistent with findings in cat motoneurones suggesting a shallower after-hyperpolarization, but other mechanisms could contribute. Furthermore, our results suggest that there is an asymptotic recovery in the excitability of slow firing motoneurones towards the end of the interspike interval.

Latency of effects evoked by electrical and magnetic brain stimulation in lower limb motoneurones in man

1. The latency of effects in the tibialis anterior (TA) and soleus (Sol) muscles evoked by electrical and magnetic stimulation of the motor cortex was evaluated in human subjects by H reflex testing. Post-stimulus time histograms (PSTHs) were established for the discharge of single voluntarily activated motor units and motor-evoked potentials (MEPs) in the surface electromyogram. 2. At rest both electrical and magnetic stimulation evoked an inhibition of the Sol H reflex at the lowest intensities of stimulation. In some subjects a facilitation with an earlier onset was seen when increasing the stimulation strength. When the anode for the electrical stimulation was placed at the vertex directly above the leg motor area, the inhibition or facilitation often had the same latency as when evoked by magnetic stimulation. However, when the anode was placed 2-3 cm lateral to the vertex, effects evoked by the electrical stimulus often occurred 1-2 ms earlier. 3. Short-latency peaks in the PSTH of the discharges of single TA motor units also tended to occur earlier when evoked by electrical stimulation with the anode lateral to the vertex than when evoked by magnetic stimulation or electrical stimulation with the anode at the vertex. 4. In one subject, near-maximal electrical stimulation evoked MEPs with a latency corresponding to that seen following stimulation of the brainstem by electrodes placed bilaterally over the mastoid processes approximately 16 cm more distal. Maximal magnetic stimulation, in contrast, never resulted in responses with a latency shorter than that seen with the weakest electrical stimuli at the vertex. 5. The initial facilitation of the Sol H reflex evoked by magnetic stimulation and by electrical anodal stimulation at the vertex increased when the subject performed a voluntary plantarflexion. In contrast, the earlier facilitation evoked by electrical anodal stimulation 2-3 cm lateral to the vertex had the same size both at rest and during contraction. 6. We suggest that magnetic stimulation and electrical anodal stimulation at the vertex may preferentially activate descending cortical cells at, or close to, the cell soma. The initial responses evoked by these two stimuli may therefore be influenced by the excitability of the cortical cells. On the other hand, electrical stimulation with the anode 2-3 cm lateral to the vertex seems to often activate the axons at a deeper level. The initial responses evoked by this type of stimulation may therefore not be influenced by the excitability of the cortical cells.

Early and late motor evoked potentials reflect preset agonist-antagonist organization in lower limb muscles

A single transcranial magnetic stimulus can evoke two involuntary muscle responses in lower limb muscles of healthy humans. The purpose of the present study was to find out if these responses, when evoked during the processing period of a simple or choice reaction time task, such as ankle dorsiflexion, have specific characteristics related to the task. During the auditory reaction time, a transcranial magnetic stimulus was delivered to observe changes in the excitability of the central nervous system. A dual-cone coil was used, which effectively stimulated the fairly deep-lying lower limb motor cortex. Stimuli were delivered in a random order with 20-300-ms delays from the auditory go-signal. Motor evoked potentials (MEP) in right and left anterior tibial and soleus muscles were analyzed while early MEPs were observed invariably in both muscles; late MEPs occurred consistently only in soleus muscles. Both early and late MEP amplitudes were larger in simple reaction time trials than in choice reaction time trials. The late MEP appeared earlier in the simple reaction time task than in the choice reaction time task, reflecting faster central processing of simple reaction time tasks. The amplitude of the soleus late MEP in the simple reaction time task followed closely the amplitude of anterior tibial early MEP, suggesting a preset agonist-antagonist organization. This relationship was not present in the choice reaction time task.

Cortical stimulation and reflex excitability of spinal cord neurones in man

The H reflex technique was used to evaluate the influence exerted by cortical conditioning on the excitability of the alpha-motoneurone pool and on IA interneuronal activity (reciprocal inhibition). In ten subjects at absolute rest electrical and magnetic stimulation of the motor cortex was transcranially applied during flexor carpi radialis H reflex eliciting and in conditions of reciprocal inhibition induced by radial nerve stimulation. The time courses showed that at intensities below motor threshold, electrical brain conditioning induced an increase in the amplitude of the test reflex when the cortical shock was given 4 ms after the test H reflex. On the contrary, reciprocal inhibition was reduced by electrical cortical conditioning when the scalp stimulation was applied 2-3 ms after the test stimulus. Magnetic transcranial stimulation induced an increase of H reflex amplitude when the test shock was administered 5 and 2 ms prior to the scalp shock; it did not modify the degree of reciprocal inhibition. The experimental findings could be considered the electrophysiological manifestation of a differential cortico-spinal control on the pathway alpha-motoneurone/IA interneurone. Considerations on the delay allow the hypothesis of a further synapse between the cortico-spinal ending and the IA interneurone. Discrepancies with magnetic conditioning might be ascribed to a preferential transsynaptic action of magnetic mode of neural activation.