Frontal distribution of early cortical somatosensory evoked potentials to median nerve stimulation

Atypical visual and somatosensory adaptation in schizophrenia-spectrum disorders

Neurophysiological investigations in patients with schizophrenia consistently show early sensory processing deficits in the visual system. Importantly, comparable sensory deficits have also been established in healthy first-degree biological relatives of patients with schizophrenia and in first-episode drug-naive patients. The clear implication is that these measures are endophenotypic, related to the underlying genetic liability for schizophrenia. However, there is significant overlap between patient response distributions and those of healthy individuals without affected first-degree relatives. Here we sought to develop more sensitive measures of sensory dysfunction in this population, with an eye to establishing endophenotypic markers with better predictive capabilities. We used a sensory adaptation paradigm in which electrophysiological responses to basic visual and somatosensory stimuli presented at different rates (ranging from 250 to 2550 ms interstimulus intervals, in blocked presentations) were compared. Our main hypothesis was that adaptation would be substantially diminished in schizophrenia, and that this would be especially prevalent in the visual system. High-density event-related potential recordings showed amplitude reductions in sensory adaptation in patients with schizophrenia (N=15 Experiment 1, N=12 Experiment 2) compared with age-matched healthy controls (N=15 Experiment 1, N=12 Experiment 2), and this was seen for both sensory modalities. At the individual participant level, reduced adaptation was more robust for visual compared with somatosensory stimulation. These results point to significant impairments in short-term sensory plasticity across sensory modalities in schizophrenia. These simple-to-execute measures may prove valuable as candidate endophenotypes and will bear follow-up in future work.

Age-related changes of cortical excitability in subjects with sleep-enhanced centrotemporal spikes: a somatosensory evoked potential study

Middle-latency somatosensory evoked potentials (SEPs) of particularly large amplitude (giant) have been reported in subjects with benign childhood epilepsy with centrotemporal spikes (BECT) and in normal children, which usually show significant age-related changes. However, the mechanisms by which age modifies the appearance of centrotemporal spikes and giant SEPs in these children, are not known. The characteristics of SEPs were studied in a group of 18 subjects (10 males and 8 females, aged 7.1-17.2 years) with sleep-enhanced centrotemporal spikes, with or without BECT and the results were compared with those obtained from a group of age-matched normal controls. Giant SEPs were recorded in 6 subjects and, in 3 of these, EEG spikes evoked by hand tapping were obtained also. No subjects with giant SEPs were found in subjects older than 12 years, and an age-related decrease in amplitude of giant SEPs as this age approached was observed. Moreover, at repeated SEP recordings, a clear trend towards a more important reduction in amplitude of giant SEPs over the temporal and parietal than over the central regions was evident. The study of EEG spikes evoked by hand tapping showed a striking similarity between the averaged evoked spikes and the main negative component of giant SEPs. It was also possible to observe that the spike negative peak recorded over the central areas always preceded the same component recorded over the parietal and temporal areas by 5-15 ms. Our study seems to support the idea that giant SEPs in subjects with centrotemporal spikes are generated by a complex mechanism different from that at the basis of the normal N60 component of SEPs; they also show peculiar age-related modifications which can be interpreted in terms of maturational changes of brain excitability/inhibition and probably constitute a tool for monitoring the clinical course of BECT, when present.

Neural generators of early cortical somatosensory evoked potentials in the awake monkey

Controversy continues to exist regarding the generators of the initial cortical components of the somatosensory evoked potential (SEP). This issue was explored by detailed epidural and intracortical mapping of somatosensory evoked activity in Old World monkeys. In depth recordings, 3 complementary procedures were utilized: (1) the intracortical and subcortical distribution of SEPs was determined from approximately 4000 locations; (2) concomitant profiles of multiple unit activity (MUA) were recorded as an estimate of local action potential profiles; (3) 1-dimensional calculations of current source density (CSD) were used to outline the timing and pattern of regional transmembrane current flow. Our analysis confirms the participation of multiple cortical areas, located on either side of the central sulcus, in the generation of the initial cortical SEP components. Earliest activity P10, was localized to area 3, followed within milliseconds by activation of areas 1, 2 (P12), and 4 (P13). In SI (Brodmann's areas 3, 1 and 2), the initial SEP components reflect the depolarization of lamina 4 stellate cells and the subsequent activation of adjacent pyramidal cells in laminae 3 and 5. The genesis of later cortical components (P20, N45) represents the composite of activity distributed across multiple cortical laminae and the interaction of overlapping excitatory and inhibitory events. These findings have direct implications for the clinical interpretation of SEP waveforms.

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.

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.

Short latency somatosensory evoked potentials recorded around the human upper brain-stem

We analyzed the intracranial spatiotemporal distributions of the N18 component of short latency median nerve somatosensory evoked potentials (SSEPs) in 3 patients with epilepsy. In these patients, depth electrodes were implanted bilaterally into the frontal and temporal lobes, with targets including the amygdala and hippocampus; the latter two targets are close to the upper pons and midbrain. In this study N18 was divided into the initial negative peak (N18a) and the following prolonged negativity (N18b). Mapping around the upper pons and midbrain showed that: (1) the amplitude of the first negativity, which coincided with scalp N18a, was larger contralateral to the side of stimulation, but showed no polarity change around the upper brain-stem; and (2) the second negativity, which was similar to scalp N18b, did show an amplitude difference or a polarity change. This wave appeared to reflect a positive-negative dipole directed in a dorso-ventral as well as dorso-lateral direction from the midbrain, where positivity arises from the dorsum of the midbrain, contralateral to the side of the stimulation. Recordings from depth electrode derivations oriented in a caudo-rostral direction suggest that N18a and N18b may in part reflect neural activity originating from the upper pons to midbrain region which projects to the rostral subcortical white matter of the frontal lobe as stationary peaks.

Scalp topography of somatosensory evoked potentials following median and posterior tibial nerve stimulation in Down's syndrome

The scalp topography of somatosensory evoked potentials (SEPs) following stimulation of the median and posterior tibial nerve of 39 patients with Down's syndrome was compared with that of age-matched normal controls using significance probability mapping (SPM). The maximal area of each potential in Down's syndrome was similar to that in normal controls, but the scalp distribution was wider. The amplitudes of all components, except the N45 and P59 potentials of the posterior tibial nerve SEPs, were greater in Down's syndrome, and the t values calculated by SPM were significantly greater. However, the difference of SEP maps between Down's patients and aged controls (over 65 years) was much smaller than that between Down's patients and age-matched controls. Therefore, we conclude that the generator sources and generating mechanisms of SEPs in Down's syndrome are not different from those of normal control, however SEP potentials in Down's syndrome are remarkably enhanced, resulting in a wider distribution, probably due to accelerated aging in Down's patients.

Assessing brain function in post-traumatic coma by means of bit-mapped SEPs, BAEPs, CT, SPET and clinical scores. Prognostic implications

Sixty-eight severely head injured comatose patients were studied. Bit-colour-mapped SEPs to median nerve stimulation, BAEPs, CT and SPET regional values and ICP were assessed in relation to clinical information in evaluating cerebral function. All these variables were related to a 1-year outcome. Statistical tests confirmed the higher predictive reliability of both neurophysiological and perfusive (SPET) functional parameters compared to CT structural findings. Generally, SEPs appeared to be more reliable in predicting outcome than BAEPs. Modifications of frontal components could occur independently of post-central ones, being closely related to underlying cerebral lesions. The parameter showing the greatest correlation with outcome in the first recording session was the P25 latency, whereas this prognostic role was mainly assumed by the amplitude value of the frontal N30-P45 complex in a second recording session carried out during the third week following head trauma.

The late somatosensory evoked potential in premature and term infants. II. Topography and latency development

The maturation of latency and scalp voltage topography of the simultaneously bilateral somatosensory evoked potential was studied in 53 neurologically intact pre-term and term infants, from 31 to 40 weeks post-menstrual age. Four peaks (N1, P1, N2 and P2) were reliably identified in all infants. The latency of each peak decreased as the infants matured. Each peak had a unique voltage scalp topography that remained stable as infants matured, even though the maps changed in amplitude intensity. N2 was large, easily identifiable with a central peak, and extremely stable in topography, suggesting that it might be used to evaluate the functional status of the somatosensory cortex in pre-term and term infants who are at high risk for developing intracranial hemorrhage leading to abnormalities of tone and delays in motor development.

The late somatosensory evoked potential in premature and term infants. I. Principal component topography

Very little is known about the topographic distribution of the cortical somatosensory evoked potential in premature infants. Principal component analysis (PCA) was applied to the wave forms generated from right median nerve stimuli over a relatively long sweep (483 msec post stimulus) at 16 electrodes in 53 infants with postconceptual ages from 31 to 40 weeks, subdivided into 5 groups by 2 week increments. Factor scores were averaged across subjects, within groups and displayed as topographical maps. Four factors accounted for 71-76% of the variance in each of the 5 groups and the factors extracted from the PCA performed independently in each group were markedly consistent. The first factor (N1/P1) had a left posterior minimum and a left frontal-central maximum and probably represents a tangential dipole located in the post-central gyrus. The second factor (N2) was characterized by a consistent left central minimum with a systematic developmental change in the maximum that seemed to imply that its neural generator was changing in orientation as the infants matured. A third factor (N3) accounted for the most variance and appeared to represent the first evidence of activity in the ipsilateral cortex. Finally, a very late fourth factor appeared only in the more mature groups, with uncertain localization. The topographic maps of the factor scores for these 4 factors appear to account for independent generators in the SEP of the premature and term infant.

SEPs to finger joint input lack the N20-P20 response that is evoked by tactile inputs: contrast between cortical generators in areas 3b and 2 in humans

A method using a DC servo motor is described to produce brisk angular movements at finger interphalangeal joints in humans. Small passive flexions of 2 degrees elicited sizable somatosensory evoked potentials (SEPs) starting with a contralateral positive P34 parietal response thought to reflect activation of a radial equivalent dipole generator in area 2 which receives joint inputs. By contrast, electric stimulation of tactile (non-joint) inputs from the distal phalanx evoked the usual contralateral negative N20 reflecting a tangential equivalent dipole generator in area 3b. Finger joint inputs also evoked a precentral positivity equivalent to the P22 of motor area 4, and a large frontal negativity equivalent to N30. It is suggested that natural stimulation allows human SEP components to be differentiated in conjunction with distinct cortical somatotopic projections.

Right or left ear reference changes the voltage of frontal and parietal somatosensory evoked potentials

Short-latency cortical somatosensory evoked potentials (SEPs) to left median nerve stimulation were recorded with either the left or right earlobe as reference. With a right earlobe reference the voltage of the parietal N20 and P27 was reduced while the voltage of the frontal P20 and N30 was enhanced. The effects were consistent, but their size varied with the SEP component considered and also among the subjects. Analysis of SEPs at different scalp sites and at either earlobe suggested that the ear contralateral to the side stimulated picked up transient potential differences, depending a.o. on side asymmetry and geometry of the neural generators as disclosed in topographic mapping. For example, the right ear potential can be shifted negatively by the right N20 field evoked by left median nerve stimulation. The changes involve the absolute potential values, but not the time features or the gradients of potential fields. Scalp current density (SCD) maps are not affected. The results are pertinent for current discussions about which reference to use and document the practical recommendation of recording short-latency cortical SEPs with a reference at the ear ipsilateral (not contralateral) to the side of stimulation.

Somatosensory evoked potentials to median nerve stimulation after partial section of the corpus callosum

Cortical somatosensory evoked potentials (SEPs) to electrical stimulation of the median nerve were studied in four patients with intractable epilepsy who had undergone callosotomy and in a patient with infarction in the corpus callosum in order to determine whether the corpus callosum was involved in the generation of ipsilateral frontal components. Both pre- and postoperative SEPs were recorded in three of four epileptic patients. There were no significant differences in the latencies and amplitudes of the bilateral frontal components (P20, N26) between pre- and postoperative recordings. Furthermore, irrespective of the extent of the section or lesion in the corpus callosum, the nature of the impairment and the existence of the disconnection syndrome, the SEP findings showed no significant differences compared with those of normal subjects. It thus appears unlikely that the ipsilateral SEP responses are transmitted from the contralateral hemisphere through at least the anterior portion of the corpus callosum.

Projection of thenar muscle afferents to frontal and parietal cortex of human subjects

There is some controversy about the projection of muscle afferents from the human upper limb to cerebral cortex and about their contribution to somatosensory evoked potentials. In 8 normal volunteers, the somatosensory projections of muscle and cutaneous afferents from the hand were recorded at 21 scalp sites, using a non-cephalic reference. Low-threshold thenar muscle afferents were selectively activated by intramuscular microstimulation. In addition, the averaged data for the projections were mapped for each individual. In each subject a focal parietal negativity was detected over the contralateral parietal cortex at a mean latency of 20.8 msec (S.D. 1.15 msec) following stimulation of thenar muscle afferents. The amplitude of the parietal 'N20-P25' was relatively small (mean 0.49 microV, range 0.18-1.56 microV). A small focal positivity was detected, maximal over contralateral frontal cortex at 22.8 msec (S.D. 2.05 msec) but recorded bilaterally. In all subjects subcortical positive waves (P9 and P14) were defined for the muscle afferent volley. This pattern of cortical activity was similar to that for the projection from the digital nerves of the index finger. For the cutaneous input the latency of the parietal 'N20' was 21.7 msec (S.D. 1.17 msec) and of the frontal 'P22' was 24.2 msec (S.D. 3.09 msec). The amplitude of the parietal 'N20-P25' was larger for the cutaneous projection (mean 1.59 microV; range 0.65-4.28 microV).

Emulation of somatosensory evoked potential (SEP) components with the 3-shell head model and the problem of 'ghost potential fields' when using an average reference in brain mapping

In brain topographic mapping, the putative location and orientation in the head space of neural generators are currently inferred from the features of negative and positive scalp potential fields. This procedure requires the use of a fairly neutral reference. The frequently advocated average reference creates problems because its effect is not merely to change a (steady) zero reference level, but to dynamically zero-center all scalp potentials at each latency. Ghost potential fields are thus created at the latencies for which the integral of scalp recorded potentials differs from zero. These distortions of brain mapping have been analyzed with a true 3-shell head model in conjunction with the emulation of SEP components. In the head model, surface potential fields generated by dipoles or dipole sheets of various depths and orientations were computed either over the north hemisphere, so as to emulate scalp recorded SEP components, or over the entire equivalent head sphere. The spurious effects of the average reference are shown to occur because it is computed from a limited number of (scalp) electrodes which fail to survey the bottom half of the head.

Inadequacy of the average reference for the topographic mapping of focal enhancements of brain potentials

The main reason for doing topographic mapping of EEG or evoked potentials is to assess regional changes in brain potentials. The use of an average reference is shown to have perverse effects in this relation, namely because it imposes on the recorded data a zero-centering effect which can reduce, eliminate or even reverse the focal changes of bit-mapped brain potentials. Concurrent studies on a true 3-shell head model suggest that such distortions of human EEG data occur because the average reference is computed from a set of (scalp) recording electrodes which do not survey the bottom half of the head volume so that the integral of scalp-recorded potentials frequently differs from zero. The results also raise the question whether the actual incidence of radial or near-radial (versus tangential) generators has been underestimated in the published data using average reference mapping.

Topographic analysis in brain mapping can be compromised by the average reference

The average reference introduces ghost potential fields at the latencies for which the integral of scalp-recorded potentials differs from zero. These spurious effects occur because the average reference is computed from a limited number of (scalp) electrodes which do not survey the bottom half of the head. By arbitrarily re-setting the zero at each latency in the maps to be compared, it can also obliterate or even reverse topographical differences in the case of focal brain potentials enhancements thereby defeating the purpose of brain mapping.