Human supplementary motor area is active in preparation for both voluntary muscle relaxation and contraction: subdural recording of Bereitschaftspotential

Event-Related Brain Potentials N140 and P300 during Somatosensory Go/NoGo Tasks Are Modulated by Movement Preparation

The Go/NoGo task requires attention and sensory processing to distinguish a motor action cue or 'Go stimulus' from a 'NoGo stimulus' requiring no action, as well as motor preparation for a rapid Go stimulus response. The neural activity mediating these response phases can be examined non-invasively by measuring specific event-related brain potentials (ERPs) using electroencephalography. However, it is critical to determine how different task conditions, such as the relationship between attention site and movement site, influence ERPs and task performance. In this study, we compared attention-associated ERP components N140 and P300, the performance metrics reaction time (RT) and accuracy (%Error) and movement-related cortical potentials (MRCPs) between Go/NoGo task trials in which attention target and movement site were the same (right index finger movement in response to right index finger stimulation) or different (right index finger movement in response to fifth finger stimulation). In other Count trials, participants kept a running count of target stimuli presented but did not initiate a motor response. The N140 amplitudes at electrode site Cz were significantly larger in Movement trials than in Count trials regardless of the stimulation site-movement site condition. In contrast, the P300 amplitude at Cz was significantly smaller in Movement trials than in Count trials. The temporal windows of N140 and P300 overlapped with the MRCP. This superposition may influence N140 and P300 through summation, possibly independent of changes in attentional allocation.

Beyond Avoiding Hemiplegia after Glioma Surgery: The Need to Map Complex Movement in Awake Patient to Preserve Conation

Improving the onco-functional balance has always been a challenge in glioma surgery, especially regarding motor function. Given the importance of conation (i.e., the willingness which leads to action) in patient's quality of life, we propose here to review the evolution of its intraoperative assessment through a reminder of the increasing knowledge of its neural foundations-based upon a meta-networking organization at three levels. Historical preservation of the primary motor cortex and pyramidal pathway (first level), which was mostly dedicated to avoid hemiplegia, has nonetheless shown its limits to prevent the occurrence of long-term deficits regarding complex movement. Then, preservation of the movement control network (second level) has permitted to prevent such more subtle (but possibly disabling) deficits thanks to intraoperative mapping with direct electrostimulations in awake conditions. Finally, integrating movement control in a multitasking evaluation during awake surgery (third level) enabled to preserve movement volition in its highest and finest level according to patients' specific demands (e.g., to play instrument or to perform sports). Understanding these three levels of conation and its underlying cortico-subcortical neural basis is therefore critical to propose an individualized surgical strategy centered on patient's choice: this implies an increasingly use of awake mapping and cognitive monitoring regardless of the involved hemisphere. Moreover, this also pleads for a finer and systematic assessment of conation before, during and after glioma surgery as well as for a stronger integration of fundamental neurosciences into clinical practice.

Brain functional activity of swallowing: A meta-analysis of functional magnetic resonance imaging

BACKGROUND

Swallowing is one of the most important activities in our life and serves the dual roles of nutritional intake and eating enjoyment.

OBJECTIVE

The study aimed to conduct a meta-analysis to investigate the brain activity of swallowing.

METHODS

Studies of swallowing using functional magnetic resonance imaging were reviewed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wan Fang before 30 November 2021. Two authors analysed the studies for eligibility criteria. The final inclusion of studies was decided by consensus. An activation likelihood estimation (ALE) meta-analysis of these studies was performed with GingerALE, including 16 studies.

RESULTS

For swallowing, clusters with high activation likelihood were found in the bilateral insula, bilateral pre-central gyrus, bilateral post-central gyrus, left transverse temporal gyrus, right medial front gyrus, bilateral inferior frontal gyrus and bilateral cingulate gyrus. For water swallowing, clusters with high activation likelihood were found in the bilateral inferior frontal gyrus and the left pre-central gyrus. For saliva swallowing, clusters with high activation likelihood were found in the bilateral cingulate gyrus, bilateral pre-central gyrus, left post-central gyrus and left transverse gyrus.

CONCLUSION

This meta-analysis reflects that swallowing is regulated by both sensory and motor cortex, and saliva swallowing activates more brain areas than water swallowing, which would promote our knowledge of swallowing and provide some direction for clinical and other research.

Circumscribed supplementary motor area injury with gait apraxia including freezing of gait and shuffling gait: a case report

Clinical findings in cases of injury circumscribed with SMA is no consensus. We report the case of a 60-year-old male with circumscribed SMA injury who showed freezing of gait, and shuffling gait. Twenty-one days after onset, the patient showed difficulties with the left leg swing in gait initiation (freezing of gait). In steady-state gait, the stride of the left leg swing was short (shuffling gait). Thirty-four days after onset, this phenomenon was not observed during gait. Circumscribed SMA injury can cause gait apraxia, including freezing and shuffling gait, such as in extensive SMA injury in the medial frontal cortex.

Brain Activity Underlying Muscle Relaxation

Fine motor control of not only muscle contraction but also muscle relaxation is required for appropriate movements in both daily life and sports. Movement disorders such as Parkinson’s disease and dystonia are often characterized by deficits of muscle relaxation. Neuroimaging and neurophysiological studies suggest that muscle relaxation is an active process requiring cortical activation, and not just the cessation of contraction. In this article, we review the neural mechanisms of muscle relaxation, primarily utilizing research involving transcranial magnetic stimulation (TMS). Several studies utilizing single-pulse TMS have demonstrated that, during the relaxation phase of a muscle, the excitability of the corticospinal tract controlling that particular muscle is more suppressed than in the resting condition. Other studies, utilizing paired-pulse TMS, have shown that the intracortical inhibition is activated just before muscle relaxation. Moreover, muscle relaxation of one body part suppresses cortical activities controlling other body parts in different limbs. Therefore, the cortical activity might not only be a trigger for muscle relaxation of the target muscles but could also bring about an inhibitory effect on other muscles. This spread of inhibition can hinder the appropriate contraction of muscles involved in multi-limb movements such as those used in sports and the play of musical instruments. This may also be the reason why muscle relaxation is so difficult for beginners, infants, elderly, and the cognitively impaired.

The effect of conscious intention to act on the Bereitschaftspotential

The current study investigated the effect of conscious intention to act on the Bereitschaftspotential. Situations in which the awareness of acting is minimally expressed were generated by asking 16 participants to press a button after performing a mental imagery task based on animal pictures (automatic condition). The affective responses induced by the pictures were controlled by selecting the animals according to different valences, threatening and neutral. The Bereitschaftspotential associated with the button presses was compared to the observed when similar movements were performed under the basic instructions of the self-paced movement paradigm (willed condition). Enhanced Bereitschaftspotential amplitudes were observed in the willed condition with respect to the automatic condition. This effect was manifested as a negative slope at medial frontocentral sites during the last 500 ms before movement onset. The valence of the pictures did not affect the motor preparatory potentials. The results suggest that significant part of the NS' subcomponent of the readiness potential is associated with the attention to-and, presumably, awareness of-intention to move, possibly reflecting cortical activation from supplementary motor areas. Secondarily, our findings supports that the feeling of threat does not influence the Bereitschaftspotential associated with automatic movements. Regarding methodological issues, the behavioural model of spontaneous voluntary movements proposed in automatic condition can benefit investigations on purely motor (or non-cognitive) subcomponents of the Bereitschaftspotential.

Cortical Activation Resulting from Painless Vibrotactile Dental Stimulation Measured by Functional Magnetic Resonance Imaging (fMRI)

There have been few investigations on hemodynamic responses in the human cortex resulting from dental stimulation. Identification of cortical areas involved in stimulus perception may offer new targets for pain treatment. This initial study aimed at establishing a cortical map of dental representation, based on non-invasive fMRI measurements. Five right-handed subjects were studied. Eight maxillary and 8 mandibular teeth were stimulated after the vibratory perception threshold was determined for each tooth. Suprathreshold stimulation was repeated thrice per session, in a total of three sessions performed on three consecutive days. Statistical inference on cluster level identified increased blood-oxygen-level-dependent signal during vibratory dental stimulation, primarily in the insular cortex bilaterally and in the supplementary motor cortex. No significant brain activation was observed in the somatosensory cortex with this stimulation protocol. These results agree with previous findings obtained from invasive direct electrical cortical stimulation of the human insula.

Ramping activity is a cortical mechanism of temporal control of action

A fundamental feature of the mammalian cortex is to guide movements in time. One common pattern of neural activity observed across cortical regions during temporal control of action is ramping activity. Ramping activity can be defined as consistent increases or decreases in neuronal firing rate across behaviorally relevant epochs of time. Prefrontal brain regions, including medial frontal and lateral prefrontal cortex, are critical for temporal control of action. Ramping is among the most common pattern of neural activity in these prefrontal areas during behavioral tasks. Finally, stimulating prefrontal neurons in medial frontal cortex can influence the timing of movement. These data can be helpful in approaching human diseases with impaired temporal of action, such as Parkinson's disease and schizophrenia. Cortical ramping activity might contribute to new diagnostic and therapeutic strategies for these and other debilitating human diseases.

Time Course of Corticospinal Excitability and Intracortical Inhibition Just before Muscle Relaxation

Using transcranial magnetic stimulation (TMS), we investigated how short-interval intracortical inhibition (SICI) was involved with transient motor cortex (M1) excitability changes observed just before the transition from muscle contraction to muscle relaxation. Ten healthy participants performed a simultaneous relaxation task of the ipsilateral finger and foot, relaxing from 10% of their maximal voluntary contraction (MVC) force after the go signal. In the simple reaction time (RT) paradigm, single or paired TMS pulses were randomly delivered after the go signal, and motor evoked potentials (MEPs) were recorded from the right first dorsal interosseous (FDI) muscle. We analyzed the time course prior to the estimated relaxation reaction time (RRT), defined here as the onset of voluntary relaxation. SICI decreased in the 80-100 ms before RRT, and MEPs were significantly greater in amplitude in the 60-80 ms period before RRT than in the other intervals in single-pulse trials. TMS pulses did not effectively increase RRT. These results show that cortical excitability in the early stage, before muscle relaxation, plays an important role in muscle relaxation control. SICI circuits may vary between decreased and increased activation to continuously maintain muscle relaxation during or after a relaxation response. With regard to M1 excitability dynamics, we suggest that SICI also dynamically changes throughout the muscle relaxation process.

Excitability changes in primary motor cortex just prior to voluntary muscle relaxation

We postulated that primary motor cortex (M1) activity does not just decrease immediately prior to voluntary muscle relaxation; rather, it is dynamic and acts as an active cortical process. Thus we investigated the detailed time course of M1 excitability changes during muscle relaxation. Ten healthy participants performed a simple reaction time task. After the go signal, they rapidly terminated isometric abduction of the right index finger from a constant muscle force output of 20% of their maximal voluntary contraction force and performed voluntary muscle relaxation. Transcranial magnetic stimulation pulses were randomly delivered before and after the go signal, and motor evoked potentials (MEPs) were recorded from the right first dorsal interosseous muscle. We selected the time course relative to an appropriate reference point, the onset of voluntary relaxation, to detect excitability changes in M1. MEP amplitude from 80 to 60 ms before the estimated electromyographic offset was significantly greater than that in other intervals. Dynamic excitability changes in M1 just prior to quick voluntary muscle relaxation indicate that cortical control of muscle relaxation is established through active processing and not by simple cessation of activity. The cortical mechanisms underlying muscle relaxation need to be reconsidered in light of such dynamics.

Muscle contraction and relaxation-response time in response to on or off status of visual stimulus

Background

It is unclear whether response time is affected by a stimulus cue, such as a light turned on or off, or if there are differences in response to these cues during a muscle contraction task compared with a muscle relaxation task. The objective of this study was to assess the response time of a relaxation task, including the contraction portion of the task, to a stimulus of a light turned on or off. In addition, we investigated the effect of the pre-contraction level on the relaxation task.

Results

Contraction response time was significantly shorter during the light-on status than during the light-off status (P <0.01), and relaxation response time in each maximum voluntary contraction was significantly longer during the light-on status than during the light-off status (P <0.01). The relaxation response time became longer in order of 25% to 75% maximum voluntary contraction regardless of light-on or -off status, and was significantly longer than the contraction response time (P <0.05-0.01).

Conclusions

This study found that as the contraction level increased, the relaxation response time became longer than the contraction response time regardless of light status. However, contraction response time or relaxation response time findings were opposite to this during the light-on status and light-off status: contraction response time became shorter in the light-on status than in the light-off status and relaxation response time became longer in the light-on status than in the light-off status. These results suggest that the length of each response time is affected by motor control in the higher order brain and involves specific processing in the visual system.

What makes the dorsomedial frontal cortex active during reading the mental states of others?

The dorsomedial frontal part of the cerebral cortex is consistently activated when people read the mental states of others, such as their beliefs, desires, and intentions, the ability known as having a theory of mind (ToM) or mentalizing. This ubiquitous finding has led many researchers to conclude that the dorsomedial frontal cortex (DMFC) constitutes a core component in mentalizing networks. Despite this, it remains unclear why the DMFC becomes active during ToM tasks. We argue that key psychological and behavioral aspects in mentalizing are closely associated with DMFC functions. These include executive inhibition, distinction between self and others, prediction under uncertainty, and perception of intentions, all of which are important for predicting others' intention and behavior. We review the literature supporting this claim, ranging in fields from developmental psychology to human neuroimaging and macaque electrophysiology. Because perceiving intentions in others' actions initiates mentalizing and forms the basis of virtually all types of social interaction, the fundamental issue in social neuroscience is to determine the aspects of physical entities that make an observer perceive that they are intentional beings and to clarify the neurobiological underpinnings of the perception of intentionality in others' actions.

Subdural interhemispheric grid electrodes for intracranial epilepsy monitoring: feasibility, safety, and utility

Object

Intracranial monitoring for epilepsy has been proven to enhance diagnostic accuracy and provide localizing information for surgical treatment of intractable seizures. The authors investigated their experience with interhemispheric grid electrodes (IHGEs) to assess the hypothesis that they are feasible, safe, and useful.

Methods

Between 1992 and 2010, 50 patients underwent IHGE implantation (curvilinear double-sided 2 × 8 or 3 × 8 grids) as part of arrays for invasive seizure monitoring, and their charts were retrospectively reviewed.

Results

Of the 50 patients who underwent intracranial investigation with IHGEs, 38 eventually underwent resection of the seizure focus. These 38 patients had a mean age of 30.7 years (range 11–58 years), and 63% were males. Complications as a result of IHGE implantation consisted of transient leg weakness in 1 patient. Of all the patients who underwent resective surgery, 21 (55.3%) had medial frontal resections, 9 of whom (43%) had normal MRI results. Localization in all of these cases was possible only because of data from IHGEs, and the extent of resection was tailored based on these data. Of the 17 patients (44.7%) who underwent other cortical resections, IHGEs were helpful in excluding medial seizure onset. Twelve patients did not undergo resection because of nonlocalizable or multifocal disease; in 2 patients localization to the motor cortex precluded resection. Seventy-one percent of patients who underwent resection had Engel Class I outcome at the 2-year follow-up.

Conclusions

The use of IHGEs in intracranial epilepsy monitoring has a favorable risk profile and in the authors' experience proved to be a valuable component of intracranial investigation, providing the sole evidence for resection of some epileptogenic foci.

Cortical activities associated with voluntary movements and involuntary movements

Recent advance in non-invasive techniques including electrophysiology and functional neuroimaging has enabled investigation of control mechanism of voluntary movements and pathophysiology of involuntary movements in human. Epicortical recording with subdural electrodes in epilepsy patients complemented the findings obtained by the non-invasive techniques. Before self-initiated simple movement, activation occurs first in the pre-supplementary motor area (pre-SMA) and SMA proper bilaterally with some somatotopic organisation, and the lateral premotor area (PMA) and primary motor cortex (M1) mainly contralateral to the movement with precise somatotopic organisation. Functional connectivity among cortical areas has been disclosed by cortico-cortical coherence, cortico-cortical evoked potential, and functional MRI. Cortical activities associated with involuntary movements have been studied by jerk-locked back averaging and cortico-muscular coherence. Application of transcranial magnetic stimulation helped clarifying the state of excitability and inhibition in M1. The sensorimotor cortex (S1-M1) was shown to play an important role in generation of cortical myoclonus, essential tremor, Parkinson tremor and focal dystonia. Cortical myoclonus is actively driven by S1-M1 while essential tremor and Parkinson tremor are mediated by S1-M1. 'Negative motor areas' at PMA and pre-SMA and 'inhibitory motor areas' at peri-rolandic cortex might be involved in the control of voluntary movement and generation of negative involuntary movements, respectively.

Cortical and subcortical mechanisms for precisely controlled force generation and force relaxation

Gripping objects during everyday manual tasks requires the coordination of muscle contractions and muscle relaxations. The vast majority of studies have focused on muscle contractions. Although previous work has examined the motor cortex during muscle relaxation, the role of brain areas beyond motor cortex remains to be elucidated. The present study used functional magnetic resonance imaging to directly compare slow and precisely controlled force generation and force relaxation in humans. Contralateral primary motor cortex and bilateral caudate nucleus had greater activity during force generation compared with force relaxation. Conversely, right dorsolateral prefrontal cortex (DLPFC) had greater activity while relaxing force compared with generating force. Also, anterior cingulate cortex had greater deactivation while relaxing force compared with generating force. These findings were further strengthened by the fact that force output parameters such as the amplitude, rate, duration, variability, and error did not affect the brain imaging findings. These results demonstrate that the neural mechanisms underlying slow and precisely controlled force relaxation differ across prefrontal-striatal and motor cortical-striatal circuits. Moreover, this study demonstrates that the DLPFC is not only involved in slow and precisely controlled force generation, but has greater involvement in regulating slow and precisely controlled muscle relaxation.

Movement-related cortical potentials in patients with Machado-Joseph disease

OBJECTIVE

Movement-related cortical potentials (MRCP; nomenclature of MRCP components according to Shibasaki and Hallett (Shibasaki H, Hallett M. What is the Bereitschaftspotential? Clin Neurophysiol 2006;117:2341-56) were studied in patients with Machado-Joseph disease (MJD) to elucidate the pathophysiology of voluntary movement.

METHODS

We studied nine genetically proven MJD patients and eight age-matched healthy subjects. Multi-channel electroencephalogram (EEG) recordings were obtained during self-paced fast extensions of the wrist. EEG epochs were time-locked to electromyography (EMG) onset or offset of the voluntary EMG burst and averaged.

RESULTS

In the MJD patients, the early Bereitschaftspotential (early BP, -1500 to -500ms) was not affected but the late BP was reduced over the central midline area and contralaterally to the movement side. The amplitude of the fpMP, a post-movement MRCP component, was also reduced. In addition, the offset cortical potential in the first 500ms after EMG offset (Moff+500) was attenuated bilaterally over a wide cortical area.

CONCLUSIONS

Findings suggest that cortical activations associated with the initiation and termination of a voluntary movement are impaired in MJD patients.

SIGNIFICANCE

Abnormalities of pre- and post-movement MRCP components provide researchers with pathophysiological insight into voluntary motor dysfunction in MJD.

Different contributions of the corpus callosum and cerebellum to motor coordination in monkey

We investigated the different contribution of the corpus callosum (CC) and cerebellum to motor control in two macaque monkeys trained to perform a precision grip task with one or both hands. Recordings were made from antidromically identified CC cells and nearby unidentified neurons (UIDs) in the hand representation of the supplementary motor area (SMA) and compared with cells from the deep cerebellar nuclei (DCN). All cells showed their greatest modulation in activity (rate change locked to particular task event) during the movement epochs of the task (CC, 21.3 +/- 22.2; UIDs, 36.2 +/- 30.1 spike/s for contralateral trials; DCN, 63 +/- 56.4 for ipsilateral trials; mean +/- SD). Surprisingly, CC cells fired at very low basal rates compared with UIDs (3.9 +/- 4.9 vs. 10 +/- 9.1 spike/s) or DCN neurons (50.8 +/- 23.8 spike/s). However, SMA cells had the greatest rate modulation to baseline ratio (CC: 12.1 +/- 13.7; UID: 5.3 +/- 5.4; DCN: 1.7 +/- 2.0). This would allow them to code the timing of a behavioral event with better fidelity than DCN cells. A multivariate regression analysis between cell firing and EMG measured cells' representation of moment-by-moment modulations in muscle activity. CC neurons coded these real-time behavioral parameters significantly less well than the other cells types, using both linear and nonlinear models. Basal firing rate substantially constrains cell function. CC cells with low basal rates have restricted dynamic range for coding continuous parameters, but efficiently code the time of discrete behavioral events. DCN neurons with higher basal rates are better suited to control continuously variable parameters of movement.

How does the brain respond to unimodal and bimodal sensory demand in movement of the lower extremity?

Numerous electroencephalography (EEG) studies have shown that neurophysiological signals change in response to visual and sensory adaptations in upper extremity tasks. However, this has not been clearly studied in the lower extremity. In this study, we evaluated how sensory loading affects brain activations related to knee movement. Thirty-two channel EEG was recorded while ten subjects performed knee extension in four different conditions: no weight and no visual target (NWNT), weight affixed to the ankle and no visual target (WNT), no weight and a visual target (NWT), and both weight and target (WT). Surface electromyography (EMG) was recorded from the vastus medialis and vastus lateralis muscles to determine onset of the movement. EEG was epoched from -4.5 s before to 1 s after EMG onset. Epochs were averaged to acquire movement-related cortical potentials (MRCPs) of each task condition. MRCP amplitude during the pre-movement period from -2 s to EMG onset was evaluated at electrodes over motor, sensory, frontal, and parietal areas. The amplitude of the pre-movement potentials for the conditions was different across areas of interest. Over the motor area, NWNT had lower amplitude than any other condition and WT had higher amplitude than any other condition. There was no difference between unimodal NWT and WNT conditions. Mesial frontal and parietal areas showed larger MRCP to the bimodal condition than either unimodal or NWNT conditions. The parietal cortex was the only region that showed a difference between unimodal conditions with greater amplitude for NWT condition. Information concerning added sensory demand is processed by the motor cortex in a way that may be indifferent to the type of modality, but is influenced by the quantity of modalities at the level of the knee. Other brain structures such as parietal and premotor cortices respond based on the modality type to help plan appropriate strategies for motor control in response to sensory manipulations. This suggests that additional task demands in motor training may create a rich sensory environment that may be beneficial in promoting optimal neuromotor recovery.

Oscillatory cortical activity related to voluntary muscle relaxation: Influence of normal aging

OBJECTIVE

In this study we aimed to investigate if there are age-related differences in cortical oscillatory activity induced by self-paced muscular pure relaxation in comparison with muscle contraction as reference movement.

METHODS

Event-related (de)synchronization (ERD/ERS) have been recorded related to voluntary muscle contraction and relaxation in 10 young and 10 elderly right-handed healthy subjects. The muscle relaxation task consisted in a voluntary relaxation of maintained wrist extension without any overt, associated muscle contraction. The muscle contraction task corresponded to a self-initiated brief wrist extension.

RESULTS

In elderly subjects compared to young ones, mu and beta ERD preceding muscular relaxation was more widespread, beginning significantly earlier over contralateral frontocentral and parietocentral regions (p<0.05) as well as over ipsilateral regions (p<0.05). The beta synchronization was significantly attenuated (p<0.05).

CONCLUSIONS

These results suggest an alteration of inhibitory motor systems and an altered post-movement somesthetic inputs processing with normal aging. These alterations were accompanied by compensatory mechanisms.

SIGNIFICANCE

These age-related alterations during different phases of muscle relaxation could participate to explain global sensorimotor slowing observed with normal aging.

Bereitschaftspotentials recorded from the lateral part of the superior frontal gyrus in humans

To demonstrate the Bereitschaftspotentials (BPs) over the high lateral convexity in the superior frontal gyrus, movement-related cortical potentials with respect to the middle finger extension were recorded in seven patients with refractory epilepsy who underwent subdural implantation of platinum electrode grids and/or strips covering the high lateral frontal convexity. In two out of the seven patients, BPs were recorded from the electrodes placed on the superior frontal gyrus in the vicinity of the border between the medial and lateral frontal lobes, which were distinct from those recorded from the primary sensorimotor cortex. The results suggest the possible contribution of either the lateral dorsal non-primary motor area or the SMA to the generation of the BPs.

Movement-related cortical potentials in primary lateral sclerosis

OBJECTIVE

Some patients with primary lateral sclerosis (PLS) have a clinical course suggestive of a length-dependent dying-back of corticospinal axons. We measured movement-related cortical potentials (MRCPs) in these patients to determine whether cortical functions that are generated through short, intracortical connections were preserved when functions conducted by longer corticospinal projections were impaired.

METHODS

An electroencephalogram was recorded from scalp electrodes of 10 PLS patients and 7 age-matched healthy control subjects as they made individual finger-tap movements on a keypad. MRCPs were derived from back-averaging the electroencephalogram to the movement.

RESULTS

MRCPs produced by finger taps were markedly reduced in PLS patients, including components generated by premotor areas of the cortex as well as the primary motor cortex. In contrast, the beta-band event-related desynchronization from the motor cortex was preserved.

INTERPRETATION

These findings suggest that impairment in PLS is not limited to the distal axons of corticospinal neurons, but also affects neurons within the primary motor cortex and premotor cortical areas. The loss of the MRCP may serve as a useful marker of upper motor neuron dysfunction. Preservation of event-related desynchronization suggests that the cells of origin differ from the large pyramidal cells that generate the MRCP.

Lateral Somatotopic Organization During Imagined and Prepared Movements

Motor imagery is a complex cognitive operation that requires memory retrieval, spatial attention, and possibly computations that are analogs of the physical movements being imagined. Likewise, motor preparation may or may not involve computations that are analogs of actual movements. To test whether motor imagery or motor preparation activate representations that are specific to the body part whose movement is imagined or prepared, participants performed, imagined, and prepared hand movements while undergoing functional MRI scanning. Actual hand movements activated components of the motor system including primary motor and somatosensory cortex, the supplementary motor area, the thalamus, and the cerebellum. All of these areas showed strong lateral organization, such that moving a given hand activated the contralateral cortex and ipsilateral cerebellum most strongly. During motor imagery and motor preparation, activity throughout the motor system was much reduced relative to overt movement. However, significant lateral organization was observed during both motor imagery and motor preparation in primary motor cortex, the supplementary motor area, and the thalamus. These results support the view that the subjective experience of imagined movement is accompanied by computations that are analogs of the physical movement that is imagined. They also suggest that in this regard motor imagery and motor preparation are similar.

Propagation of tonic posturing in supplementary motor area (SMA) seizures

We analyzed ictal motor symptoms in 10 patients diagnosed to have supplementary motor area (SMA) seizures based on ictal encephalographic (EEG) findings and ictal clinical semiology. Inclusion criteria were (1) EEG seizure pattern in the vertex for the scalp recording or in the area over and/or adjacent to SMA for epicortical recording and (2) ictal motor semiology characterized, as previously reported, by sudden and a brief tonic posturing of extremities and trunk mainly occurring during sleep without loss of consciousness. In 50% (5/10) of the patients, tonic posturing began in one part of the body and moved to other part(s) in 5-10s. Unlike Jacksonian march seen in seizures involving the primary sensorimotor area (S1-M1), it spread in no accordance with the somatotopy in S1-M1. The sequential propagation of tonic posturing may represent the somatotopic organization within the SMA proper.

Awake Surgery for Glioma Resection in Eloquent Areas-Zurich's Experience and Review-

Awake surgery was performed in a series of 21 patients with gliomas in eloquent areas with the use of intraoperative electrical mapping. Gross total removal was performed in 18 patients. There was no operative mortality. Postoperative findings included no change in symptoms and signs in 10 patients, improvement of the preoperative deficit in 11 patients. Four patients had improved Karnofsky performance status (KPS) scores after surgery, 17 patients were stable, and no patient had lower KPS score. Extensive radical resection of gliomas prolongs the overall survival and improves the patient's quality of life. However, surgical resection of gliomas located within the sensorimotor or language areas remains a neurosurgical challenge in reducing eloquent neurological sequelae. Awake surgery with intraoperative functional mapping is a safe approach to maximize the extent of tumor removal and to minimize the resultant neurological deficits in the treatment of glioma involving the eloquent cortex.

Relaxation from a voluntary contraction is preceded by increased excitability of motor cortical inhibitory circuits

Termination of a muscle contraction is as important a part of movement as muscle activation yet the mechanisms responsible are less well understood. In the present experiments we examined the possible role of intracortical inhibitory circuits in terminating a 20% maximum isometric contraction of the first dorsal interosseous muscle (FDI) in eight healthy subjects. Subjects performed the task simultaneously with both hands and received single or pairs (at an interstimulus interval of 3 ms to evaluate short interval intracortical inhibition, SICI) of transcranial magnetic stimuli (TMS) via a focal coil over the motor hand area of the left hemisphere at different times before and after the onset of relaxation. The amplitude of the motor-evoked potential (MEP) following a single or a pair of TMS pulses was measured in the right FDI and plotted relative to the onset of relaxation as estimated from the surface electromyogram (EMG) of the left FDI. MEPs were larger during contraction than after relaxation whereas SICI was absent during contraction and reappeared after relaxation. We found that in all subjects, the time course of MEP changes during relaxation was closely fitted by a Boltzmann sigmoidal curve which allowed us to estimate the mean MEP amplitudes as well as the ratio of the amplitudes after single or pairs of TMS pulses (i.e.%SICI) at any time in the task. The data showed that the amplitude of MEPs to single pulse TMS had started to decline at about the same time as the onset of EMG silence. Furthermore, the size of the MEPs evoked by paired pulses decreased up to 30 ms beforehand. The latter suggests that an increase in SICI occurs prior to the onset of MEP changes, and hence that increased cortical inhibition may play a role in suppressing corticospinal excitability during relaxation. A subsidiary experiment showed that the time relations of changes in SICI and MEP were unchanged by a period of 10 min training on the task.

Muscle relaxation is impaired in dystonia: A reaction time study

A simple visual reaction time (RT) paradigm was used to investigate whether the velocity of relaxation is impaired in dystonia. In 16 subjects with a clinical diagnosis of adult-onset focal, segmental or multifocal dystonia and in 15 age-matched normal controls, the relaxation reaction time (R-RT) and the contraction reaction time (C-RT) were compared across different tasks involving the flexor carpi radialis (FCR), biceps brachii (BB) and triceps brachii (TR) arm muscles. In normal controls, the latency of EMG termination (R-RT) was significantly shorter than the latency of electromyographic (EMG) onset (C-RT) in the BB and TR muscles, but not in the FCR muscle. In dystonic patients, the latency of EMG termination (R-RT) was significantly longer than the latency of EMG onset (C-RT) in the FCR and BB muscles. No significant difference of the C-RT was observed between patients and controls whereas the R-RT was prolonged significantly in the BB and TR muscles of patients with dystonia and almost significantly in the FCR muscle. This study indicates that muscle relaxation is abnormal in patients with focal (multifocal or segmental) dystonia. The impaired muscle relaxation may contribute to the longer overlap of agonist-antagonist activities (co-contraction) typically observed in dystonia and to the slowness of voluntary movement sequencing.

Somatosensory event-related potentials (ERPs) associated with stopping ongoing movement

The somatosensory event-related potentials (ERPs) associated with stopping ongoing movement and increasing muscular tension were examined. 14 healthy right-handed volunteers, 10 men and 4 women (21-29 years old, M age +/- SD, 24.1 +/- 2.5 yr.) performed a stop/increase reaction task. They were requested to perform an elbow extension movement with the right arm and to maintain 20% of the maximum voluntary contraction forces (MVC) before the electrical stimuli were delivered to either the left index finger or the left little finger. They executed one of two movements from the sustained contraction state: they had to stop the muscular tension following the left little finger stimulus or increase the muscular tension from 20% to 40% of the maximum voluntary contraction forces following the left index finger stimulus. The reaction time and somatosensory sequence P100-N140-P300 components of event-related potentials were recorded for each electrical stimulus, respectively. The reaction time was longer to the increase reaction condition than to the stop reaction condition. Neither P100 nor N140 components showed significant differences between stop and increase reaction conditions. The P300 to the stop reaction condition was of greater amplitude and latency than those of the increase reaction condition. These results suggest that stopping the ongoing movement processing requires a longer stimulus evaluation time and is more demanding than increasing reaction processing.

Human eye fields in the frontal lobe as studied by epicortical recording of movement‐related cortical potentials

We studied the generator location of premovement subcomponents of movement-related cortical potentials (MRCPs) [Bereitschaftspotential (BP), negative slope (NS') and motor potential (MP)] associated with voluntary, self-paced horizontal saccade in the human frontal lobe. Self-paced horizontal saccade, wrist (or middle finger) extension and foot dorsiflexion were employed in 10 patients (lateral surface of the frontal lobe in seven and mesial in three) as part of the presurgical evaluation, and data of five patients (lateral in four and mesial in three) were used in the final analysis. On the lateral frontal lobe, the maximum BP, NS' or MP with horizontal saccade was seen at or 1-2 cm rostral to the hand, arm or face area of the primary motor cortex (MI) in all four subjects investigated. This area exactly corresponded to the frontal eye field (FEF) identified by electrical stimulation. The amplitude of MRCPs with saccade was smaller than that with hand movements. On the mesial surface, within the supplementary motor area (SMA) proper, BP and/or NS' for horizontal saccade was located 1-2 cm rostral to that for hand and foot movements. BP and/or NS' delineated the supplementary eye field (SEF) at the rostral part of the SMA proper, and SEF partly overlapped with the hand and foot areas of the SMA proper. At the area just rostral to the vertical anterior commissure line and/or the pre-SMA defined by electrical stimulation, BP and/or NS' was seen invariably, regardless of the sites of movements, and in contrast with the SMA proper, there was no somatotopic representation. No clear MPs were elicited by eye movements on the mesial surface. In one of the two subjects whose MRCPs with horizontal saccade were recorded simultaneously from the lateral and mesial surfaces of the frontal lobe, BP from the SEF and pre-SMA preceded that from the FEF. It is concluded that MRCPs with horizontal saccade are useful for defining the FEF, SEF and pre-SMA, and that the SEF and pre-SMA become active in preparation for horizontal saccade earlier than the FEF.

Relaxation in distal and proximal arm muscles: a reaction time study

OBJECTIVE

To investigate whether the same mechanisms underlie muscle relaxation in proximal and distal arm muscles of normal subjects.

METHODS

Fourteen healthy subjects were studied using a simple visual reaction time paradigm. Relaxation reaction time (R-RT) and contraction reaction time (C-RT) were compared across different tasks involving distal (first dorsal interosseus, FDI, flexor carpi radialis, FCR) and proximal (biceps brachii, BB, triceps brachii, TR) arm muscles. Changes of FCR H-reflex before and during voluntary relaxation were investigated in two subjects.

RESULTS

No significant difference was observed between R-RT and C-RT in the distal muscles. The R-RT was significantly shorter than C-RT in both the BB and TR muscles. The relaxation latency (R-RT) was significantly correlated to the subjects' age in all the muscles except the FDI. No inhibition of the FCR H-reflex could be observed in the 20 ms preceding muscle relaxation.

CONCLUSIONS

Our findings suggest that neural mechanisms contribute differently to the relaxation of muscles with a different functional role. Voluntary relaxation in distal arm muscles is mainly related to the reduction of motor cortical output, while in proximal muscles a spinal disfacilitation is also present and possibly sustained by the modulation of presynaptic inhibition.

The human prefrontal and parietal association cortices are involved in NO-GO performances: an event-related fMRI study

One of the important roles of the prefrontal cortex is inhibition of movement. We applied an event-related functional magnetic resonance imaging (fMRI) technique to observe changes in fMRI signals of the entire brain during a GO/NO-GO task to identify the functional fields activated in relation to the NO-GO decision. Eleven normal subjects participated in the study, which consisted of a random series of 30 GO and 30 NO-GO trials. The subjects were instructed to press a mouse button immediately after the GO signal was presented. However, they were instructed not to move when the NO-GO signal was presented. We detected significant changes in MR signals in relation to the preparation phases, GO responses, and NO-GO responses. The activation fields related to the NO-GO responses were located in the bilateral middle frontal cortices, left dorsal premotor area, left posterior intraparietal cortices, and right occipitotemporal area. The fields of activation in relation to the GO responses were found in the left primary sensorimotor, right cerebellar anterior lobule, bilateral thalamus, and the area from the anterior cingulate to the supplementary motor area (SMA). Brain activations related to the preparation phases were identified in the left dorsal premotor, left lateral occipital, right ventral premotor, right fusiform, and the area from the anterior cingulate to the SMA. The results indicate that brain networks consisting of the bilateral prefrontal, intraparietal, and occipitotemporal cortices may play an important role in executing a NO-GO response.

Surgical resection of grade II astrocytomas in the superior frontal gyrus

OBJECTIVE

Surgery in the superior frontal gyrus partially involving the supplementary motor area (SMA) may be followed by contralateral transient weakness and aphasia initially indistinguishable from damage to the primary motor cortex. However, recovery is different, and SMA deficits may resolve completely within days to weeks. No study has assessed the distinct postoperative deficits after tumor resection in the SMA on a homogeneous patient group.

METHODS

Twenty-four patients with World Health Organization Grade II astrocytomas in the superior frontal gyrus consecutively treated by surgery were studied. Degree and duration of postoperative deficits were evaluated according to tumor location and boundaries via magnetic resonance imaging scans, intraoperative neuromonitoring results, and extent of tumor resection.

RESULTS

Postoperatively, motor deficits were evident in 21 of 24 and speech deficits in 9 of 12 patients. Motor function quickly recovered in 11 and speech function in 3 patients. None of the 12 patients in whom the posterior tumor resection line was at a distance of more than 0.5 cm from the precentral sulcus experienced persistent motor deficits. Eight of these patients developed typical SMA syndrome with transient initiation difficulties. Seven of 12 patients in whom the tumor extended to the precentral sulcus still had motor deficits at the 12-month follow-up assessment.

CONCLUSION

Surgery for Grade II gliomas in the superior frontal gyrus is more likely to result in permanent morbidity when the resection is performed at a distance of less than 0.5 cm from the precentral gyrus or positive stimulation points. Therefore, cortical mapping of motor and speech function, in critical cases under local anesthesia with the patient as his or her own monitor, is recommended; resection should be tailored to obtain good functional outcome and maintain quality of life.

Different activation of presupplementary motor area, supplementary motor area proper, and primary sensorimotor area, depending on the movement repetition rate in humans

In order to clarify the functional role of the supplementary motor area (SMA) and its rostral part (pre-SMA) in relation to the rate of repetitive finger movements, we recorded movement-related cortical potentials (MRCPs) directly from the surface of the mesial frontal lobe by using subdural electrode grids implanted in four patients with intractable partial epilepsy. Two subregions in the SMA were identified based on the anatomical location and the different response to cortical stimulation. In three of the four subjects, we also recorded MRCPs from the surface of the lateral convexity covering the primary sensorimotor areas (SI-MI), which were defined by cortical stimulation and SEP recording. The subjects extended the middle finger or opposed the thumb against other fingers of the same hand at a self-paced rate of 0.2 Hz (slow) and 2 Hz (rapid), each in separate sessions. As a result, pre-and postmovement potentials were clearly seen at the SI-MI in both slow- and rapid-rate movements. By contrast, in the SMA, especially in the pre-SMA, premovement potentials were not seen and postmovement potentials were seldom seen in the rapid rate movement. In the slow-rate condition, pre- and postmovement potentials were clearly seen in both the pre-SMA and the SMA proper. In conclusion, the SMA, especially the pre-SMA, is less activated electrophysiologically in the rapid-rate movements, while the SI-MI remains active regardless of the movement rate.

Abnormal cortical processing of voluntary muscle relaxation in patients with focal hand dystonia studied by movement-related potentials

In order to clarify the abnormality in cortical motor preparation for voluntary muscle relaxation of the hand in patients with focal hand dystonia, Bereitschaftspotentials (BPs) preceding voluntary muscle contraction and relaxation were recorded in eight patients (three with simple writer's cramp and five with dystonic writer's cramp), and were compared with those from 10 normal subjects. Voluntary muscle relaxation: after keeping the right wrist in an extended position for > 5 s, the subject let the hand drop by voluntarily terminating muscle contraction of the wrist extensor without any associated muscle contraction. Voluntary muscle contraction: the right wrist was flexed by voluntarily contracting the wrist flexor muscle. Scalp EEGs were recorded from 11 electrodes placed over the frontal, central and parietal areas. In the control group, the BP measured at the movement onset was maximal at the left central area (C1), and distributed predominantly over the left hemisphere equally in both the contraction and relaxation tasks. In the focal hand dystonia group, BP was maximal at C1 in the contraction task, whereas, in the relaxation task, it was maximal at the midline central area (Cz) and symmetrically distributed. At the left central area, the BP amplitude in the focal hand dystonia group was diminished significantly in the relaxation task compared with the contraction task (P < 0.05). The present results demonstrate for the first time that the cortical preparatory process for voluntary muscle relaxation, or motor inhibition, is abnormal in focal hand dystonia.

Activities of the primary and supplementary motor areas increase in preparation and execution of voluntary muscle relaxation: an event-related fMRI study

Brain activity associated with voluntary muscle relaxation was examined by applying event-related functional magnetic resonance imaging (fMRI) technique, which enables us to observe change of fMRI signals associated with a single motor trial. The subject voluntarily relaxed or contracted the right upper limb muscles. Each motor mode had two conditions; one required joint movement, and the other did not. Five axial images covering the primary motor area (M1) and supplementary motor area (SMA) were obtained once every second, using an echoplanar 1.5 tesla MRI scanner. One session consisted of 60 dynamic scans (i.e., 60 sec). The subject performed a single motor trial (i.e., relaxation or contraction) during one session in his own time. Ten sessions were done for each task. During fMRI scanning, electromyogram (EMG) was monitored from the right forearm muscles to identify the motor onset. We calculated the correlation between the obtained fMRI signal and the expected hemodynamic response. The muscle relaxation showed transient signal increase time-locked to the EMG offset in the M1 contralateral to the movement and bilateral SMAs, where activation was observed also in the muscle contraction. Activated volume in both the rostral and caudal parts of SMA was significantly larger for the muscle relaxation than for the muscle contraction (p < 0.05). The results suggest that voluntary muscle relaxation occurs as a consequence of excitation of corticospinal projection neurons or intracortical inhibitory interneurons, or both, in the M1 and SMA, and both pre-SMA and SMA proper play an important role in motor inhibition.