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

Enhanced corticospinal excitability in the tibialis anterior during static stretching of the soleus in young healthy individuals

Corticospinal excitability is known to be affected by afferent inflow arising from the proprioceptors during active or passive muscle movements. Also during static stretching (SS) afferent activity is enhanced, but its effect on corticospinal excitability received limited attention and has only been investigated as a single average value spread over the entire stretching period. Using transcranial magnetic stimulation (TMS) the present study was conducted to explore the time course of corticospinal excitability during 30 seconds SS. Motor evoked potentials (MEPs) after TMS were recorded from soleus (SOL) and tibialis anterior (TA) muscles in 14 participants during: a passive dynamic ankle dorsiflexion (DF), at six different time points during maximal individual SS (3, 6, 9, 18, 21 and 25 seconds into stretching), during a passive dynamic ankle plantar flexion (PF) and following SS. To explore the time course of corticospinal excitability during the static lengthened phase of a muscle stretch, the stretching protocol was repeated several times so that it was possible to collect a sufficient number of stimulations at each specific time point into SS, as well as during DF and PF. During passive DF, MEPs amplitude was greater than baseline in both TA and SOL (p = .001 and p = .005 respectively). During SS, MEPs amplitude was greater than baseline in TA (p = .006), but not in SOL. No differences between the investigated time points were found and no trend was detected throughout the stretching time. No effect in either muscle was observed during passive PF and after SS. These results could suggest that an increased activity of secondary afferents from SOL muscle spindles exert a corticomotor facilitation on TA. The muscle-nonspecific response observed during passive DF could instead be attributed to an increased activation within the sensorimotor cortical areas as a result of the awareness of the foot passive displacements.

Contribution of different somatosensory afferent input to subcortical somatosensory evoked potentials in humans

OBJECTIVES

To investigate the subcortical somatosensory evoked potentials (SEPs) to electrical stimulation of either muscle or cutaneous afferents.

METHODS

SEPs were recorded in 6 patients suffering from Parkinson's disease (PD) who underwent electrode implantation in the pedunculopontine (PPTg) nucleus area. We compared SEPs recorded from the scalp and from the intracranial electrode contacts to electrical stimuli applied to: 1) median nerve at the wrist, 2) abductor pollicis brevis motor point, and 3) distal phalanx of the thumb. Also the high-frequency oscillations (HFOs) were analysed.

RESULTS

After median nerve and pure cutaneous (distant phalanx of the thumb) stimulation, a P1-N1 complex was recorded by the intracranial lead, while the scalp electrodes recorded the short-latency far-field responses (P14 and N18). On the contrary, motor point stimulation did not evoke any low-frequency component in the PPTg traces, nor the N18 potential on the scalp. HFOs were recorded to stimulation of all modalities by the PPTg electrode contacts.

CONCLUSIONS

Stimulus processing within the cuneate nucleus depends on modality, since only the cutaneous input activates the complex intranuclear network possibly generating the scalp N18 potential.

SIGNIFICANCE

Our results shed light on the subcortical processing of the somatosensory input of different modalities.

Attenuation of sensory processing in the primary somatosensory cortex during rubber hand illusion

The neural representation of the body is easily altered by the integration of multiple sensory signals in the brain. The “rubber hand illusion” (RHI) is one of the most popular experimental paradigms to investigate this phenomenon. During this illusion, a feeling of ownership of the rubber hand is created. Some studies have shown that somatosensory processing in the brain is attenuated when RHI occurs. However, it is unknown where attenuation of somatosensory processing occurs. Here, we show that somatosensory processing is attenuated in the primary somatosensory cortex. We found that the earliest response of somatosensory evoked potentials, which is thought to originate from the primary somatosensory cortex, was attenuated during RHI. Furthermore, this attenuation was observed before the occurrence of the illusion. Our results suggest that attenuation of sensory processing in the primary somatosensory cortex is one of the factors influencing the occurrence of the RHI.

Neuromuscular electrical stimulation-promoted plasticity of the human brain

The application of neuromuscular electrical stimulation (NMES) to paretic limbs has demonstrated utility for motor rehabilitation following brain injury. When NMES is delivered to a mixed peripheral nerve, typically both efferent and afferent fibres are recruited. Muscle contractions brought about by the excitation of motor neurons are often used to compensate for disability by assisting actions such as the formation of hand aperture, or by preventing others including foot drop. In this context, exogenous stimulation provides a direct substitute for endogenous neural drive. The goal of the present narrative review is to describe the means through which NMES may also promote sustained adaptations within central motor pathways, leading ultimately to increases in (intrinsic) functional capacity. There is an obvious practical motivation, in that detailed knowledge concerning the mechanisms of adaptation has the potential to inform neurorehabilitation practice. In addition, responses to NMES provide a means of studying CNS plasticity at a systems level in humans. We summarize the fundamental aspects of NMES, focusing on the forms that are employed most commonly in clinical and experimental practice. Specific attention is devoted to adjuvant techniques that further promote adaptive responses to NMES thereby offering the prospect of increased therapeutic potential. The emergent theme is that an association with centrally initiated neural activity, whether this is generated in the context of NMES triggered by efferent drive or via indirect methods such as mental imagery, may in some circumstances promote the physiological changes that can be induced through peripheral electrical stimulation.

Torque depression following active shortening is associated with a modulation of cortical and spinal excitation: a history-dependent study

The reduction in steady-state isometric torque following a shortening muscle action when compared to a purely isometric contraction at the same muscle length and level of activation is termed torque depression (TD). The purpose of this study was to investigate spinal and supraspinal neural responses during the TD state of a maximal voluntary activation of the ankle dorsiflexors. Thirteen subjects (10 male) were recruited for the study. To explore alterations in corticospinal excitability during voluntary muscle activation in the TD state, motor evoked potentials (MEPs), cervicomedullary motor evoked potentials (CMEPs), and maximal compound muscle action potentials (Mmax) were elicited during the isometric steady-state following active shortening (i.e., TD) and the purely isometric condition. A 15% reduction in steady-state isometric torque (P < 0.05) was observed following isokinetic shortening at 40°/sec. Although mean evoked responses (MEP and CMEP) were not different in the TD state as compared with purely isometric state, the changes in evoked responses were inversely related to one another depending on the level of TD These findings indicate that supraspinal and spinal responses are interrelated in the TD state. Furthermore, antagonist muscle coactivation during the isometric reference contraction was positively related to TD These findings suggest the possibility of a relationship between the central nervous system and TD in humans. Further work should be performed to definitively link TD to specific spinal interneurons.

Electrophysiological and spinal imaging evidences for sensory dysfunction in amyotrophic lateral sclerosis

OBJECTIVES

The prevalence of sensory impairment at an early stage of amyotrophic lateral sclerosis (ALS) is still debated. The study aim was to investigate the anatomofunctional properties of sensory pathways in patients with ALS, combining spinal diffusion tensor imaging (DTI) and somatosensory evoked potentials (SEPs).

DESIGN

Case-control study.

SETTINGS

ALS referral centre and laboratory of biomedical imaging (Paris, France).

PARTICIPANTS

Well-characterised group of 21 patients with ALS with moderate disability (mean amyotrophic lateral sclerosis Functional Rating Scale (ALSFRS) score 39.3±1.0) and no clinical sensory signs and control group of 21 gender and age-matched healthy subjects.

OUTCOME MEASURES

Fractional anisotropy and diffusivity of the dorsal columns at C5-T1 levels (DTI metrics) and SEPs after median and ulnar nerve stimulations (latency and amplitude of N9 and N20 components).

RESULTS

Abnormal DTI metrics indicated anatomical damages of ascending sensory fibres in ∼60% of patients (p<0.05). Raw SEPs (μV) were smaller in ∼40% of patients but the difference with healthy subjects was not significant (p>0.16). Their normalisation to prestimulus activity strengthened the difference between groups (p<0.05) and allowed identification of ∼60% of patients with abnormal values. According to N9 latency, the peripheral conduction time was normal in patients (p>0.32) but based on N20 latency, the central conduction time (between spinal cord and parietal cortex) was found to be slower (p<0.05). Significant correlation was found between DTI metrics and N9 amplitude (p<0.05). Altered SEPs were also correlated with the disease duration (p<0.05). Taken together, spinal imaging and electrophysiology helped to identify ∼85% of patients with subclinical sensory defect while separated methods revealed abnormal values in ∼60%.

CONCLUSIONS

Sensory impairments have been underestimated at early stages of ALS. These results show for the first time the interest to combine electrophysiology and imaging to assess non-motor system involvement in ALS.

TRIAL REGISTRATION NUMBER

IDRCB2012-A00016-37.

Cerebral, subcortical, and cerebellar activation evoked by selective stimulation of muscle and cutaneous afferents: an fMRI study

Abstract We compared the brain areas that showed significant flow changes induced by selective stimulation of muscle and cutaneous afferents using fMRI BOLD imaging. Afferents arising from the right hand were studied in eight volunteers with electrical stimulation of the digital nerve of the index finger and over the motor point of the FDI muscle. Both methods evoked areas of significant activation cortically, subcortically, and in the cerebellum. Selective muscle afferent stimulation caused significant activation in motor-related areas. It also caused significantly greater activation within the contralateral precentral gyrus, insula, and within the ipsilateral cerebellum as well as greater areas of reduced blood flow when compared to the cutaneous stimuli. We demonstrated separate precentral and postcentral foci of excitation with muscle afferent stimulation. We conclude, contrary to the findings with evoked potentials, that muscle afferents evoke more widespread cortical, subcortical, and cerebellar activation than do cutaneous afferents. This emphasizes the importance, for studies of movement, of matching the kinematic aspects in order to avoid the results being confounded by alterations in muscle afferent activation. The findings are consistent with clinical observations of the movement consequences of sensory loss and may also be the basis for the contribution of disturbed sensorimotor processing to disorders of movement.

Cortical inhibition is reduced following short-term training in young and older adults

The purpose of this study was to investigate age-related differences in short-term training adaptations in cortical excitability and inhibition. Thirty young (21.9 ± 3.1 years) and 30 older (72.9 ± 4.6 years) individuals participated in the study. Each participant was randomly assigned to a control (n = 30) or a resistance training (n = 30) group, with equal numbers of young and older subjects in each group. Participants completed 2 days of testing, separated by 2 weeks during which time the training group participated in resistance training of the ankle dorsiflexor muscles three times per week. During each testing session, transcranial magnetic stimulation was used to generate motor evoked potentials (MEPs) and silent periods in the tibialis anterior. Hoffmann reflexes (H-reflexes) and compound muscle action potentials (M-waves) were also evoked via electrical stimulation of the peroneal nerve. At baseline, young subjects had higher maximum voluntary contraction (MVC) force (p = 0.002), larger M-wave amplitude (p < 0.001), and longer duration silent periods (p = 0.01) than older individuals, with no differences in the maximal amplitude of the MEP (p = 0.23) or H-reflex (p = 0.57). In the trained group, MVC increased in both young (17.4 %) and older (19.8 %) participants (p < 0.001), and the duration of the silent period decreased by ~15 and 12 ms, respectively (p < 0.001). Training did not significantly impact MEP (p = 0.69) or H-reflex amplitudes (p = 0.38). There were no significant changes in any measures in the control group (p ≥ 0.19) across the two testing sessions. These results indicate that a reduction in cortical inhibition may be an important neural adaptation in response to training in both young and older adults.

Modulation of human corticospinal excitability by paired associative stimulation

Paired Associative Stimulation (PAS) has come to prominence as a potential therapeutic intervention for the treatment of brain injury/disease, and as an experimental method with which to investigate Hebbian principles of neural plasticity in humans. Prototypically, a single electrical stimulus is directed to a peripheral nerve in advance of transcranial magnetic stimulation (TMS) delivered to the contralateral primary motor cortex (M1). Repeated pairing of the stimuli (i.e., association) over an extended period may increase or decrease the excitability of corticospinal projections from M1, in manner that depends on the interstimulus interval (ISI). It has been suggested that these effects represent a form of associative long-term potentiation (LTP) and depression (LTD) that bears resemblance to spike-timing dependent plasticity (STDP) as it has been elaborated in animal models. With a large body of empirical evidence having emerged since the cardinal features of PAS were first described, and in light of the variations from the original protocols that have been implemented, it is opportune to consider whether the phenomenology of PAS remains consistent with the characteristic features that were initially disclosed. This assessment necessarily has bearing upon interpretation of the effects of PAS in relation to the specific cellular pathways that are putatively engaged, including those that adhere to the rules of STDP. The balance of evidence suggests that the mechanisms that contribute to the LTP- and LTD-type responses to PAS differ depending on the precise nature of the induction protocol that is used. In addition to emphasizing the requirement for additional explanatory models, in the present analysis we highlight the key features of the PAS phenomenology that require interpretation.

Nociceptive contribution to the evoked potentials after painful intramuscular electrical stimulation

Our study aimed at investigating the nociceptive contribution to the somatosensory evoked potentials after electrical intramuscular stimulation (mSEPs) at painful intensity. Scalp mSEPs were recorded in 10 healthy subjects after electrical stimulation of the left brachioradialis muscle at three intensities: non-painful (I2), slightly painful (I4) and moderately painful (I6). For each intensity, mSEPs were recorded in a neutral condition (NC) in which subjects did not have any task, and in an attention condition (AC) in which subjects were asked to count the number of stimuli. In both NC and AC, the N120 and P220 amplitudes were significantly higher at I6 than at I2. While the N120 amplitude did not vary between NC and AC, the P220 amplitude was significantly higher in AC than in NC at all stimulus intensities. Our results suggest that nociceptive inputs contribute to the N120 amplitude increase at painful stimulus intensity, while the P220 amplitude is more sensitive to changes of subjects' attention level. Therefore, the N120 amplitude increase to moderately painful stimuli, as compared to non-painful stimuli, may represent a marker of the activation of the muscular thin myelinated afferents.

LTP-like changes induced by paired associative stimulation of the primary somatosensory cortex in humans: source analysis and associated changes in behaviour

Paired associative stimulation (PAS), which combines repetitive peripheral nerve stimulation with transcranial magnetic stimulation (TMS), may induce neuroplastic changes in somatosensory cortex (S1), possibly by long-term potentiation-like mechanisms. We used multichannel median nerve somatosensory evoked potential (MN-SSEP) recordings and two-point tactile discrimination testing to examine the location and behavioural significance of these changes. When TMS was applied to S1 near-synchronously to an afferent signal containing mechanoreceptive information, MN-SSEP changes (significant at 21-31 ms) could be explained by a change in a tangential source located in Brodmann area 3b, with their timing and polarity suggesting modification of upper cortical layers. PAS-induced MN-SSEP changes between 28 and 32 ms were linearly correlated with changes in tactile discrimination. Conversely, when the near-synchronous afferent signal contained predominantly proprioceptive information, PAS-induced MN-SSEP changes (20-29 ms) were shifted medially, and tactile performance remained stable. With near-synchronous mechanoreceptive stimulation subtle differences in the timing of the two interacting signals tended to influence the direction of tactile performance changes. PAS performed with TMS delivered asynchronously to the afferent pulse did not change MN-SSEPs. Hebbian interaction of mechanoreceptive afferent signals with TMS-evoked activity may modify synaptic efficacy in superficial cortical layers of Brodmann area 3b and is associated with timing-dependent and qualitatively congruent behavioural changes.

Evidence for early activation of primary motor cortex and SMA after electrical lower limb stimulation using EEG source reconstruction

Compared to median nerve somatosensory evoked potentials (SEP), less is known about activity evoked by nerve stimulation of the lower limb. To understand the mechanisms and the physiology of sensor- and motor control it is useful to investigate the sensorimotor functions as revealed by a standardized functional status. Therefore, we investigated SEPs of the lower limb in 6 healthy male volunteers. For each side, tibial and peroneal nerves were stimulated transcutaneously at the fossa poplitea. The tibial nerves were also stimulated further distally at the ankle joint. Source localization was applied to 64-EEG-channel data of the SEPs. In contrast to somatosensory areas, which are activated after median nerve stimulation, we found dipoles adjacent to motor areas near Brodmann area 4 (BA 4) for SEP components P 32/40 and P 54/60 and near the supplementary motor area (SMA) for the N 75/83 component. These sources could reliably be distinguished for each individual subject as well as for the grand mean data set. Our data show that afferent projections from the lower limb mainly reach primary motor areas (BA 4) and only subsequently, with a delay of 40 ms, higher order motor areas such as SMA. We conclude that a focused view on SEP of the lower limb could be a useful tool to investigate pathological states in motor control or peripheral deafferentiation.

Pre-movement modulation of tibial nerve SEPs caused by a self-initiated dorsiflexion

OBJECTIVE

To investigate the centrifugal effect on somatosensory evoked potentials (SEPs), we recorded the pre-movement modulation of SEPs following stimulation of the tibial nerve caused by a self-initiated dorsiflexion.

METHODS

SEPs following stimulation of the right tibial nerve at the popliteal fossa were recorded during self-initiated dorsiflexion of the right ankle every 5-7s. Based on the onset of Bereitschaftspotential and negative slope, the preparatory period before dorsiflexion was divided into four sub-periods (pre-BP, BP1a, BP1b and BP2 sub-period), and SEPs in each sub-period were averaged. SEPs were also recorded in a stationary condition.

RESULTS

P30, N40, P50 and N70 were identified at Cz in all subjects. The amplitude of P30 was significantly smaller in the BP2 sub-period than in the pre-BP sub-period. The N40 amplitude was significantly attenuated in the BP2 sub-period compared with the stationary condition, the pre-BP sub-period, the BP1a sub-period and the BP1b sub-period.

CONCLUSIONS

These results suggested that the motor-related areas involved in generating negative slope modulated the tibial nerve SEPs preceding a self-initiated contraction of the agonist muscle.

SIGNIFICANCE

The centrifugal gating effect on SEPs extends to the somatosensory information from the antagonistic body part.

Nerve specific modulation of somatosensory inflow to cerebral cortex during submaximal sustained contraction in first dorsal interosseous muscle

Modulation of the early component (latency approximately 20-30 ms) of somatosensory evoked potentials (SEPs) and that of the middle and long latency cutaneous reflexes was examined in 13 healthy volunteers during fatiguing submaximal voluntary contraction (20% maximum) of the first dorsal interosseous muscle (FDI). The SEP was evoked by stimulating the ulnar nerve (U-SEP), a mixed nerve innervating the FDI muscle, the purely cutaneous nerves of the 2nd digit (D2-SEP) and the 5th digit (D5-SEP). The cutaneous reflex was recorded concurrently with D2-SEP. The size of D2- and D5-SEP significantly decreased during fatiguing contraction as compared to rest, and the decrease in both SEPs persisted throughout fatiguing contraction. In contrast, the significant decrease in the gating of U-SEP disappeared during the latter phase of fatiguing contraction. The ratio (reflex response/background EMG) of excitatory E2 (latency approximately 60-90 ms) and E3 (approximately 120-180 ms) responses following D2 stimulation significantly increased during the middle or latter phase of fatiguing contraction. In contrast, no significant changes in inhibitory I1 and I2 were seen. The release of the attenuation of U-SEP and a constant gating of the D2- and D5-SEP suggests that the brain selectively permits the muscular afferent inflow into the cortex during fatiguing contraction. An increase in the E2 and E3 reflex ratio of cutaneous reflexes during the later phase of fatiguing contraction most likely results from an increase in the excitability of the motor cortex.

Spatiotemporal brain dynamics in response to muscle stimulation

The objective of the present study was to assess the spatiotemporal scenario of brain activity associated with sensory stimulation of the abductor pollicis brevis muscle. Spatiotemporal dipole models, using realistic individual boundary element head models, were built from somatosensory evoked potentials (SEPs; 64 Ch. EEG) to nonpainful and painful intramuscular electrostimulation (IMES) as well as to cutaneous electrostimulation delivered to the distal phalanx of the thumb. Nonpainful and painful muscle stimuli resulted in activation of the same brain regions. In temporal order, these were: the contralateral primary sensorimotor cortex, contralateral dorso-lateral premotor area (PM), bilateral operculo-insular cortices, caudal cingulate motor area (CMA), and posterior cingulate cortex/precuneus. Brain processing induced by muscle sensory input showed a characteristic pattern in contrast to cutaneous sensory input, namely: (1) no early SEP components to IMES; (2) an initial IMES component likely generated by proprioceptive input is not present for digit stimulation; (3) one source was located in the PM only for IMES. This source was unmasked by the lower stimulus intensity; (4) a source for IMES was located in the contralateral caudal CMA rather than being located in the cingulate gyrus. Cerebral sensory processing of input from the muscle involved several sensory and motor areas and likely occurs in two parallel streams subserving higher order somatosensory processing as well as sensory-motor integration. The two streams might on one hand involve sensory discrimination via SI and SII and on the other hand integration of sensory feedback for further motor processing via MI, lateral PM area, and caudal CMA.

Spatial resolution of fMRI in the human parasylvian cortex: Comparison of somatosensory and auditory activation

In spite of its outstanding spatial resolution, the biological resolution of functional MRI may be worse because it depends on the vascular architecture of the brain. Here, we compared the activation patterns of the secondary somatosensory and parietal ventral cortex (SII/PV) with that of the primary auditory cortex and adjacent areas (AI/AII). These two brain regions are located immediately adjacent to each other on opposite banks of the Sylvian fissure, and are anatomically and functionally distinct. In 12 healthy subjects, SII/PV was activated by pneumatic tactile stimuli applied to the index finger (0.5 cm2 contact area, 4 bar pressure), and AI/AII by amplitude-modulated tones (800 Hz carrier frequency, modulated at 24-36 Hz). Functional images were obtained with a 1.5-T scanner and were evaluated using SPM99. Sensitivity of fMRI activation in this unselected sample was 71% for tactile and 83% for auditory stimulation. Group analysis showed activation of SII/PV by tactile and activation of three locations in AI/AII by auditory stimuli. Distributions extended to the opposite side of the fissure (19-58% after tactile and 13-14% after auditory stimulation, depending on the side of stimulation/hemisphere). Morphometry of individual sulcal anatomy revealed that the course of the Sylvian fissure varied by 5.3 mm (SD) in vertical direction. Taking this into account, SII/PV was located 5.8 +/- 2.7 mm above the Sylvian fissure, whereas AI/AII was located 6.3 +/- 1.7 mm below the Sylvian fissure. Even in individual analysis, the most significant voxel after tactile stimuli in one subject was found on the "wrong" side of the fissure; this error could be ascribed to the spatial normalization procedure. These data show that fMRI signals may overlap substantially, even if the activated regions are separated by 12 mm across a major sulcus. Spatial normalization to an atlas template can introduce additional variance. Individual sulcal anatomy should be preferred over mean atlas locations.

Intraneural microstimulation of motor axons in the study of human single motor units

Single motor unit activity has been studied in depth since the first intramuscular electrodes were developed more than 70 years ago. Many techniques have been combined or used in isolation since then. Intraneural motor axon microstimulation allows the detailed study of single motor units in awake human subjects in a manner most analogous to that used in reduced animal preparations. A microelectrode, inserted percutaneously into a peripheral nerve, stimulates the axon of a single alpha-motoneuron at a site remote from the contracting muscle, allowing detailed analyses of the contractile properties of a single motor unit in an otherwise quiescent muscle, that is, without interference of simultaneously active motor units or the presence of an electrode within the muscle. The methods and results obtained using this technique are described and compared to those of other studies of single motor units in human subjects. Differences have been found between human and animal motor units and between motor units of various muscles. Studying human and animal motor units using an analogous technique provides insight into the interpretation of human data when results differ from animal data, and when human motor units cannot be examined in the same way, or at a similar level of detail, as animal motor units.

Modality-related scalp responses after electrical stimulation of cutaneous and muscular upper limb afferents in humans

To elucidate whether the selective electrical stimulation of muscle as well as cutaneous afferents evokes modality-specific responses in somatosensory evoked potentials (SEPs) recorded on the scalp of humans, we compared scalp SEPs to electrical stimuli applied to the median nerve and to the abductor pollicis brevis (APB) motor point. In three subjects, we also recorded SEPs after stimulation of the distal phalanx of the thumb, which selectively involved cutaneous afferents. Motor point and median nerve SEPs showed the same scalp distribution; moreover, very similar dipole models, showing the same dipolar time courses, explained well the SEPs after both types of stimulation. Since the non-natural stimulation of muscle afferents evokes responses also in areas specifically devoted to cutaneous input processing, it is conceivable that, in physiological conditions, muscle afferents are differentially gated in somatosensory cortex. The frontocentral N30 response was absent after purely cutaneous stimulation; by contrast, it was relatively more represented in motor point rather than in mixed nerve SEPs. These data suggest that the N30 response is specifically evoked by proprioceptive inputs.

Effect of movement on dipolar source activities of somatosensory evoked potentials

The early scalp somatosensory evoked potentials (SEPs) to median and tibial nerve stimulation were recorded at rest and during voluntary movement of the stimulated hand and foot, respectively. Both tibial and median nerve SEP distributions at rest could be explained by four-dipole models, in which one dipole was activated at the same latency as the subcortical far field and the three remaining dipolar sources were located in the perirolandic region contralateral to the stimulated side. Voluntary movement reduced all cortical dipoles in strength, while the subcortical one remained unchanged, suggesting that the effect of movement occurs above the cervicomedullary junction. In animals, cutaneous inputs are suppressed during movement and we therefore interpreted the depression of activity in the primary somatosensory cortex induced by movement as due to selective "gating" of cutaneous afferents. Because the reduction in strength of the cortical dipoles was generally lower during passive than active movement, both centrifugal and centripetal mechanisms probably contribute to the phenomenon of "gating."

Different contribution of joint and cutaneous inputs to early scalp somatosensory evoked potentials

To elucidate whether the frontal components of scalp somatosensory evoked potentials (SEPs) depend on the type of peripheral input, we compared scalp SEPs in response to electrical stimuli applied to: (i) the proximal phalanx of the thumb, involving both deep and cutaneous afferents; and (ii) the distal phalanx of the thumb, involving cutaneous afferents, but excluding joint inputs coming from the interphalangeal articulation. We applied the same dipolar model that we built to explain the scalp SEP distribution to median nerve stimulation in previous investigations. Cortical SEPs after proximal stimulation were generated by three dipolar sources, one of which was likely to account for the frontal scalp N30. When we analyzed SEPs for distal (purely cutaneous) stimulation, the frontal and central recordings showed a clear reduction in amplitude of the negative responses having a latency of about 30 ms. Moreover, when applying the dipole model derived from analysis of responses to proximal stimulation to SEPs to distal stimulation, the source corresponding to the N30 distribution showed no activity, suggesting a strong relationship between joint and tendinous inputs and the activity of the N30 generator.

Brain electrical source analysis of primary cortical components of the tibial nerve somatosensory evoked potential using regional sources

Tibial nerve somatosensory evoked potentials (SEPs) show higher amplitudes ipsilateral to the side of stimulation, whereas subdural recordings revealed a source in the foot area of the contralateral hemisphere. We now investigated this paradoxical lateralization by performing a brain electrical source analysis in the P40 time window (34-46 ms). The tibial nerve was stimulated behind the ankle (8 subjects). On each side, 2048 stimuli were applied twice. SEPs were recorded using 32 magnetic resonance imaging (MRI)-verified electrode positions (bandpass 0.5-500 Hz). In each case, the P40 amplitude was higher ipsilaterally (0.45 +/- 0.14 microV) than contralaterally (-0.49 +/- 0.16 microV). The best fitting regional source, however, was always located in the contralateral hemisphere with a mean distance of 8.2 +/- 4.3 mm from the midline. The positivity pointed ipsilaterally shifting from a frontal orientation (P37) to a parietal direction (P40). The P40 dipole moment was 2.5 times stronger than the dipole moment of P37, which makes P40 most prominent in EEG recordings. However, with its oblique dipole orientation compared to the tangential P37 dipole, it is systematically underestimated in MEG. Dipole orientations explained interindividual variability of scalp potential distribution. SEP amplitudes were smaller when generated in the dominant (left) hemisphere. This is explained by deeper located sources (5.4 +/- 1.6 mm) with a more tangential orientation (delta theta = 17.5 +/- 2.3 degrees) in the left hemisphere.

Ipsilateral median somatosensory evoked potentials recorded from human somatosensory cortex

Somatosensory evoked potentials (SEP) to ipsilateral and contralateral median nerve stimulations were recorded from subdural electrode grids over the perirolandic areas in 41 patients with medically refractory focal epilepsies who underwent evaluation for epilepsy surgery. All patients showed clearly defined, high-amplitude contralateral median SEPs. In addition, four patients showed ipsilateral SEPs. Compared with the contralateral SEPs, ipsilateral SEPs were very localized, had a different spatial distribution, were of considerably lower amplitude, had a longer latency (1.2-17.8 ms), did not show an initial negativity, and were markedly attenuated during sleep. Stimulation of the subdural electrodes overlying the sensory hand area was associated with contralateral hand paresthesias, but no ipsilateral hand paresthesias, occurred. It was concluded that subdurally recorded cortical SEPs to ipsilateral stimulation of the median nerve (M) reflect unconscious sensory input from the hand possibly serving fast bimanual hand control. The anatomical pathway of these ipsilateral short-latency MSEPs is not yet known. Transcallosal transmission seems unlikely because of the short delay between the ipsilateral and contralateral responses in selected cases. The infrequent occurrence of ipsilateral subdurally recorded SEPs and their low amplitude and limited distribution suggest that they contribute very little to the short-latency ipsilateral median SEPs recorded on the scalp.

Afferent mechanism of cortical myoclonus studied by proprioception-related SEPs

Proprioception-related somatosensory evoked potentials (SEPs) to passive flexion movement of the middle finger at proximal interphalangeal joint were recorded in 7 patients with myoclonus of cortical origin who demonstrated enlarged electrical SEPs (giant SEPs). In 3 out of the 7 patients, the proprioception-related SEPs were also enlarged. The remaining 4 patients showed giant electrical SEPs without enhancement of proprioception-related SEPs. Long loop electromyographic response was recorded during the resting condition in all of the 3 patients with enlarged proprioception-related SEPs. We have previously reported that proprioception-related SEPs are mainly generated by muscle afferent inputs, though electrical SEPs are thought to reflect mostly cutaneous inputs with some contribution from muscle afferents. Therefore, it is concluded that hyperexcitability of the sensorimotor cortex in cortical myoclonus is modality-specific. Cortical excitability is exaggerated to both cutaneous and deep receptor inputs in some patients, but only to cutaneous input in others.

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.

The effects of stimulus rates upon median, ulnar and radial nerve somatosensory evoked potentials

We examined the effect of stimulus rates on the somatosensory evoked potential (SEP) amplitude following stimulation of the median nerve (MN) and the ulnar nerve (UN) at the elbow or wrist, and the radial nerve (RN) at the wrist in 12 normal subjects. We measured the amplitude of frontal (P14-N18-P22-N30) and parietal peaks (P14-N20-P26-N34) at a stimulus rate of 1.1, 3.5 and 5.7 Hz. The amplitude attenuation was found at frontal P22 and N30 and to a lesser degree at parietal N20 and P26 peaks with an increasing stimulus rate from 1.1 to 5.7 Hz. The amplitude attenuation was greatest at the elbow when compared to the wrist stimulation for both MN and UN. The attenuation was least for wrist stimulation for the RN. The UN block by local anesthesia just distal to the stimulus electrode at the elbow abolished the amplitude attenuation caused by the fast stimulus rate. The observed amplitude attenuation with the faster stimulus rate is probably due, in part, to interference from the "secondary" afferent inputs. The secondary afferent inputs arise from peripheral receptor stimulation (muscle, joint and/or cutaneous) as a subsequent effect of efferent volleys initiated from the point of stimulation. The greater number of peripheral receptors being activated as more proximal sites of stimulation in a mixed nerve would result in greater attenuation of the SEP recorded from scalp electrodes. We postulate that the attenuation of frontal peaks by the fast stimulus rate is due to the frontal projection of interfering "secondary" afferent inputs.

Somatosensory evoked potentials (SEPs) elicited by magnetic nerve stimulation

Magnetic stimulation of peripheral nerves at distal and proximal sites of the upper and lower extremities and at the midlumbar level were used to elicit cortical somatosensory evoked potentials. Evidence is provided that peripheral nerve trunks, rather than distal receptor afferents, are the anatomical structures stimulated by the electromagnetic fields. Magnetic stimulation of peripheral nerves is considered to be useful for an evaluation of the integrity of proximal nerves, nerve roots and central conduction along sensory pathways. In contrast to electrical nerve stimulation, magnetic stimulation is painless and can be applied to proximal nerves and plexus. By means of proximal nerve stimulation central sensory conduction can be tested even in patients with peripheral nerve lesions or polyneuropathy.

Steady-state vibration evoked potentials: descriptions of technique and characterization of responses

Steady-state scalp evoked potentials were recorded in response to amplitude modulated vibration applied to the fingers and palmar surface of one hand. Evoked response dependence on the frequency of amplitude modulation in the 2-40 Hz range was studied in a group of normal young adult volunteers. Response amplitude was greatest at low amplitude modulation frequencies. The greatest signal to EEG noise ratios were found at modulation frequencies near 26 Hz. At modulation frequencies near 26 Hz the steady-state response latency was found to be 58 +/- 14 msec. Inverse dipole modeling localized the steady-state evoked response generators in or near somatosensory cortex with the dipole moment orientation being predominantly in the anterior-posterior direction.