Hemispheric lateralization in the cortical motor preparation for human vocalization

Reductions in Cortico-Striatal Hyperconnectivity Accompany Successful Treatment of Obsessive-Compulsive Disorder with Dorsomedial Prefrontal rTMS

Obsessive-compulsive disorder (OCD) is a disabling illness with high rates of nonresponse to conventional treatments. OCD pathophysiology is believed to involve abnormalities in cortico-striatal-thalamic-cortical circuits through regions such as dorsomedial prefrontal cortex (dmPFC) and ventral striatum. These regions may constitute therapeutic targets for neuromodulation treatments, such as repetitive transcranial magnetic stimulation (rTMS). However, the neurobiological predictors and correlates of successful rTMS treatment for OCD are unclear. Here, we used resting-state functional magnetic resonance imaging (fMRI) to identify neural predictors and correlates of response to 20-30 sessions of bilateral 10 Hz dmPFC-rTMS in 20 treatment-resistant OCD patients, with 40 healthy controls as baseline comparators. A region of interest in the dmPFC was used to generate whole-brain functional connectivity maps pre-treatment and post treatment. Ten of 20 patients met the response criteria (⩾50% improvement on Yale-Brown Obsessive-Compulsive Scale, YBOCS); response to dmPFC-rTMS was sharply bimodal. dmPFC-rTMS responders had higher dmPFC-ventral striatal connectivity at baseline. The degree of reduction in this connectivity, from pre- to post-treatment, correlated to the degree of YBOCS symptomatic improvement. Baseline clinical and psychometric data did not predict treatment response. In summary, reductions in fronto-striatal hyperconnectivity were associated with treatment response to dmPFC-rTMS in OCD. This finding is consistent with previous fMRI studies of deep brain stimulation in OCD, but opposite to previous reports on mechanisms of dmPFC-rTMS in major depression. fMRI could prove useful in predicting the response to dmPFC-rTMS in OCD.

Cortical involvement in the StartReact effect

The rapid release of prepared movements by a loud acoustic stimulus capable of eliciting a startle response has been termed the StartReact effect (Valls-Solé et al., 1999), and premotor reaction times (PMTs) of <70 ms are often observed. Two explanations have been given for these short latency responses. The subcortical storage and triggering hypothesis suggests movements that can be prepared in advance of a "go" signal are stored and triggered from subcortical areas by a startling acoustic stimulus (SAS) without cortical involvement. Alternatively, it has been hypothesized that the SAS can trigger movements from cortical areas through a faster pathway ascending from subcortical structures. Two experiments were designed to examine the possible role of the primary motor cortex in the StartReact effect. In Experiment 1, we used suprathreshold transcranial magnetic stimulation (TMS) during the reaction time (RT) interval to induce a cortical silent period in the contralateral primary motor cortex (M1). Thirteen participants performed 20° wrist extension movements as fast as possible in response to either a control stimulus (82 dB) or SAS (124 dB). PMTs for startle trials were faster than for control trials, while TMS significantly delayed movement onset compared to No TMS or Sham TMS conditions. In Experiment 2, we examined the StartReact effect in a highly cortically represented action involving speech of a consonant-vowel (CV) syllable. Similar to previous work examining limb movements, a robust StartReact effect was found. Collectively, these experiments provide evidence for cortical (M1) involvement in the StartReact effect.

Resting-state cortico-thalamic-striatal connectivity predicts response to dorsomedial prefrontal rTMS in major depressive disorder

Despite its high toll on society, there has been little recent improvement in treatment efficacy for major depressive disorder (MDD). The identification of biological markers of successful treatment response may allow for more personalized and effective treatment. Here we investigate whether resting-state functional connectivity predicted response to treatment with repetitive transcranial magnetic stimulation (rTMS) to dorsomedial prefrontal cortex (dmPFC). Twenty-five individuals with treatment-refractory MDD underwent a 4-week course of dmPFC-rTMS. Before and after treatment, subjects received resting-state functional MRI scans and assessments of depressive symptoms using the Hamilton Depresssion Rating Scale (HAMD17). We found that higher baseline cortico-cortical connectivity (dmPFC-subgenual cingulate and subgenual cingulate to dorsolateral PFC) and lower cortico-thalamic, cortico-striatal, and cortico-limbic connectivity were associated with better treatment outcomes. We also investigated how changes in connectivity over the course of treatment related to improvements in HAMD17 scores. We found that successful treatment was associated with increased dmPFC-thalamic connectivity and decreased subgenual cingulate cortex-caudate connectivity, Our findings provide insight into which individuals might respond to rTMS treatment and the mechanisms through which these treatments work.

Bilateral coordination and the motor basis of female preference for sexual signals in canary song

The preference of female songbirds for particular traits in the songs of courting males has received considerable attention, but the relationship of preferred traits to male quality is poorly understood. Female domestic canaries (Serinus canaria, Linnaeus) preferentially solicit copulation with males that sing special high repetition rate, wide-band, multi-note syllables, called 'sexy' or A-syllables. Syllables are separated by minibreaths but each note is produced by pulsatile expiration, allowing high repetition rates and long duration phrases. The wide bandwidth is achieved by including two notes produced sequentially on opposite sides of the syrinx, in which the left and right sides are specialized for low or high frequencies, respectively. The emphasis of low frequencies is facilitated by a positive relationship between syllable repetition rate and the bandwidth of the fundamental frequency of notes sung by the left syrinx, such that bandwidth increases with increasing syllable repetition rate. The temporal offset between notes prevents cheating by unilaterally singing a note on the left side with a low fundamental frequency and prominent higher harmonics. The syringeal and respiratory motor patterns by which sexy syllables are produced support the hypothesis that these syllables provide a sensitive vocal-auditory indicator of a male's performance limit for the rapid, precisely coordinated interhemispheric switching, which is essential for many sensory and motor processes involving specialized contributions from each cerebral hemisphere.

Grasp it loudly! Supporting actions with semantically congruent spoken action words

Evidence for cross-talk between motor and language brain structures has accumulated over the past several years. However, while a significant amount of research has focused on the interaction between language perception and action, little attention has been paid to the potential impact of language production on overt motor behaviour.

The aim of the present study was to test whether verbalizing during a grasp-to-displace action would affect motor behaviour and, if so, whether this effect would depend on the semantic content of the pronounced word (Experiment I). Furthermore, we sought to test the stability of such effects in a different group of participants and investigate at which stage of the motor act language intervenes (Experiment II). For this, participants were asked to reach, grasp and displace an object while overtly pronouncing verbal descriptions of the action (“grasp” and “put down”) or unrelated words (e.g. “butterfly” and “pigeon”).

Fine-grained analyses of several kinematic parameters such as velocity peaks revealed that when participants produced action-related words their movements became faster compared to conditions in which they did not verbalize or in which they produced words that were not related to the action. These effects likely result from the functional interaction between semantic retrieval of the words and the planning and programming of the action.

Therefore, links between (action) language and motor structures are significant to the point that language can refine overt motor behaviour.

Primary motor cortical metaplasticity induced by priming over the supplementary motor area

Motor cortical plasticity induced by repetitive transcranial magnetic stimulation (rTMS) sometimes depends on the prior history of neuronal activity. These effects of preceding stimulation on subsequent rTMS-induced plasticity have been suggested to share a similar mechanism to that of metaplasticity, a homeostatic regulation of synaptic plasticity. To explore metaplasticity in humans, many investigations have used designs in which both priming and conditioning are applied over the primary motor cortex (M1), but the effects of priming stimulation over other motor-related cortical areas have not been well documented. Since the supplementary motor area (SMA) has anatomical and functional cortico-cortical connections with M1, here we studied the homeostatic effects of priming stimulation over the SMA on subsequent rTMS-induced plasticity of M1. For priming and subsequent conditioning, we employed a new rTMS protocol, quadripulse stimulation (QPS), which produces a broad range of motor cortical plasticity depending on the interval of the pulses within a burst. The plastic changes induced by QPS at various intervals were altered by priming stimulation over the SMA, which did not change motor-evoked potential sizes on its own but specifically modulated the excitatory I-wave circuits. The data support the view that the homeostatic changes are mediated via mechanisms of metaplasticity and highlight an important interplay between M1 and SMA regarding homeostatic plasticity in humans.

Primary face motor area as the motor representation of articulation

No clinical data have yet been presented to show that a lesion localized to the primary motor area (M1) can cause severe transient impairment of articulation, although a motor representation for articulation has been suggested to exist within M1. Here we describe three cases of patients who developed severe dysarthria, temporarily mimicking speech arrest or aphemia, due to a localized brain lesion near the left face representation of the human primary motor cortex (face-M1). Speech was slow, effortful, lacking normal prosody, and more affected than expected from the degree of facial or tongue palsy. There was a mild deficit in tongue movements in the sagittal plane that impaired palatolingual contact and rapid tongue movements. The speech disturbance was limited to verbal output, without aphasia or orofacial apraxia. Overlay of magnetic resonance images revealed a localized cortical region near face-M1, which displayed high intensity on diffusion weighted images, while the main portion of the corticobulbar fibers arising from the lower third of the motor cortex was preserved. The cases suggest the existence of a localized brain region specialized for articulation near face-M1. Cortico-cortical fibers connecting face-M1 with the lower premotor areas including Broca's area may also be important for articulatory control.

Simulating single word processing in the classic aphasia syndromes based on the Wernicke-Lichtheim-Geschwind theory

The Wernicke-Lichtheim-Geschwind (WLG) theory of the neurobiological basis of language is of great historical importance, and it continues to exert a substantial influence on most contemporary theories of language in spite of its widely recognized limitations. Here, we suggest that neurobiologically grounded computational models based on the WLG theory can provide a deeper understanding of which of its features are plausible and where the theory fails. As a first step in this direction, we created a model of the interconnected left and right neocortical areas that are most relevant to the WLG theory, and used it to study visual-confrontation naming, auditory repetition, and auditory comprehension performance. No specific functionality is assigned a priori to model cortical regions, other than that implicitly present due to their locations in the cortical network and a higher learning rate in left hemisphere regions. Following learning, the model successfully simulates confrontation naming and word repetition, and acquires a unique internal representation in parietal regions for each named object. Simulated lesions to the language-dominant cortical regions produce patterns of single word processing impairment reminiscent of those postulated historically in the classic aphasia syndromes. These results indicate that WLG theory, instantiated as a simple interconnected network of model neocortical regions familiar to any neuropsychologist/neurologist, captures several fundamental "low-level" aspects of neurobiological word processing and their impairment in aphasia.

Chapter 2 Studying higher cerebral functions by transcranial magnetic stimulation

TMS can be used to study higher cerebral functions by the virtual lesion paradigm. The major advantages of this method are that it could be used to produce a lesion anywhere the researcher wants without confusing cortical reorganization, and that it helps to establish a chain of cause and effect between the activity of the brain and behavior. With elucidation of the mechanism underlying the cortical function blocking, this technique will open up new possibilities for studying higher cerebral functions. In contrast to the online method in which TMS is delivered while subjects perform a certain task, the off-line method uses repetitive TMS to achieve lasting effects even after stimulation has ceased. The application of the offline method will extend from improving cognitive functions by TMS to the treatment of neurological and psychiatric patients.

The role of dorsal premotor area in reaction task: comparing the "virtual lesion" effect of paired pulse or theta burst transcranial magnetic stimulation

We compared the effect on reaction times of transient interference with function of the dorsal premotor cortex (PMd) using a pair (25-ms interval) of transcranial magnetic stimulation (TMS) pulses with long-term interference produced by a new repetitive TMS paradigm known as "theta burst stimulation" (TBS). Pairs of TMS pulses over left PMd increased choice but not simple reaction times of the right hand if given at the onset of the reaction interval. There was no effect of stimulation over right PMd or at a midline parietal control site (Pz). In contrast, TBS over either left or right PMd increased choice RTs of both hands for at least 5-10 min after the end of TBS. Pairs of TMS pulses over left PMd also increased error rates whereas TBS had no effect on error rates despite the effect on RTs. We suggest that TBS leads to widespread changes in activity and more complex effects on behaviour than expected from the paired pulse TMS and conclude that transient and long-term forms of interference with function may influence behavioural tasks in subtly different ways.

Motor cortex dynamics in visuomotor production of speech and non-speech mouth movements

We investigated timing and hemispheric balance of motor cortex activation when kinetically similar speech and non-speech mouth movements and sequences of such movements were triggered by visually presented letter- and symbol-strings. As an index of motor cortex activation, we used magnetoencephalographic recording of task-related change of precentral 20 Hz (16-24 Hz) activity. Suppression of the 20 Hz rhythm revealed pre-movement activation in the face representation areas that was tied to visual instruction, not movement onset. The 20 Hz rhythm remained suppressed throughout the preparation and execution of mouth movements and was followed by post-movement rebound. Left hemisphere preceded the right at the onset and offset of the suppression, similarly for isolated and sequential speech and non-speech movements. Pattern of task-related change in 20 Hz activity was otherwise symmetrical. In the face areas, the overall modulation of 20 Hz activity increased with sequence length and motor demands. Hand representation areas showed also weak reactivity, with systematically larger modulation of 20 Hz activity for non-speech than speech movements. Our results suggest an active role for the motor cortex in cognitive control of visually triggered mouth movements, not limited to movement execution.

Increased corticospinal excitability after 5 Hz rTMS over the human supplementary motor area

Transcranial magnetic stimulation (TMS) can produce effects not only at the site of stimulation but also at distant sites to which it projects. Here we examined the connection between supplementary motor area (SMA) and the hand area of the primary motor cortex (M1(Hand)) by testing whether prolonged repetitive TMS (rTMS) over the SMA can produce changes in excitability of the M1(Hand) after the end of the stimulus train. We evaluated motor-evoked potentials (MEPs) and the cortical silent period (CSP) evoked by a single-pulse TMS, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) produced by a paired-pulse TMS, and forearm flexor H reflexes before and after 750 pulses of 5 Hz rTMS over SMA at an intensity of 110% active motor threshold (AMT) for the first dorsal interosseous (FDI) muscle. The amplitude of MEPs recorded from the right FDI muscle at rest as well as during voluntary contraction increased for at least 10 min after the end of rTMS, although the duration of the CSP, SICI and ICF did not change. There was no effect on H reflexes in the flexor carpi radialis muscle, even though the amplitude of the MEP obtained from the same muscle increased after rTMS. The effects on MEPs depended on the intensity of rTMS and were spatially specific to the SMA proper. We suggest that 5 Hz rTMS over SMA can induce a short-lasting facilitation in excitability of the M1(Hand) compatible with the anatomical connections between SMA and the M1(Hand).

Interhemispheric Transmission of Visuomotor Information for Motor Implementation

Using transcranial magnetic stimulation (TMS), we addressed the contribution of both hemispheres to the visuomotor control of each hand. The subjects had to press one of two buttons as quickly as possible after the go-signal. A precue preceding this conveyed full, partial or no advance information (hand and/or button), such that reaction time (RT) shortened with increasing amount of information. We gave TMS over each hemisphere at various time intervals (100-350 ms) after the go-signal and before the expected onset of response, and measured its effect on RT, movement time (MT) and error rate. At short intervals (100-200 ms), left hemisphere TMS delayed RT and prolonged MT of both hands, while right hemisphere TMS delayed RT only of the right hand, without affecting error rates. At long intervals (250-350 ms), TMS produced slightly more pronounced RT delays of the contralateral hand. RT was delayed more if the precues were less informative. The results suggest the importance of interhemispheric transmission of visuomotor information for motor implementation. The right hemisphere may play a role mainly in calculating target and effector information, determining RT, while the left hemisphere may play a role in elaborating the motor program and determining MT.

High-frequency transcranial magnetic stimulation of the supplementary motor area reduces bimanual coupling during anti-phase but not in-phase movements

Previous electrophysiological and neuroimaging studies have provided evidence that the supplementary motor area (SMA) has an important role in the control of bimanual coordination. The present experiment investigated the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the SMA region on kinematic variables during cyclical bimanual coordination, with a particular focus on the quality of coordination. Subjects performed metronome-paced trials of in-phase and anti-phase bimanual index-finger movements at near-maximal cycling frequency. During movement execution, rTMS (20 Hz, 0.5 s, 120% hand motor threshold) was applied over one of three positions in the sagittal midline 2.0, 4.0 and 6.0 cm anterior to the primary motor leg area. Sham rTMS was included as a control condition. After rTMS, the mean relative phase error between hands increased, but only in the anti-phase trials. The maximum increase in phase error occurred immediately after rather than during the rTMS train. The effect was largest after stimulation 4 or 6 cm anterior to the leg area of the primary motor cortex. We did not observe any changes in the variability of relative phase or in cycle duration or movement amplitude. Findings are discussed in light of recent functional models on the role of the SMA in bimanual movement control.

Callosum and movement control: case reports

This article explores the role of directionality of callosal traffic (codified as handedness), based on personal clinical observations and a critical review of the literature. Based on this evidence, a technical definition of handedness is offered as opposed to the behavioral method in use until now. In the vast majority of right-handers neural and behavioral handedness match. The situation is the opposite in left-handers where two thirds of them are wired to be right-handers, causing the well-known heterogeneity seen in left-handed cohorts. The callosum-length proximity of the dominant side of the body to the command center in the major hemisphere is the source of its neurophysiological superiority compared to the nondominant side. Clinical syndromes in which the new scheme are manifested are reviewed, indicating the existence of an excitatory influence by the neuronal aggregate devoted to voluntary actions, housed in the major hemisphere, on their counterparts in the minor hemisphere. The latter is exclusively devoted to volitional movements occurring on the nondominant side. Thus, it is the directionality of callosal traffic that is responsible for cerebral asymmetries seen in the motor realm.

Neural pathways underlying vocal control

Vocalization is a complex behaviour pattern, consisting of essentially three components: laryngeal activity, respiratory movements and supralaryngeal (articulatory) activity. The motoneurones controlling this behaviour are located in various nuclei in the pons (trigeminal motor nucleus), medulla (facial nucleus, nucl. ambiguus, hypoglossal nucleus) and ventral horn of the spinal cord (cervical, thoracic and lumbar region). Coordination of the different motoneurone pools is carried out by an extensive network comprising the ventrolateral parabrachial area, lateral pontine reticular formation, anterolateral and caudal medullary reticular formation, and the nucl. retroambiguus. This network has a direct access to the phonatory motoneurone pools and receives proprioceptive input from laryngeal, pulmonary and oral mechanoreceptors via the solitary tract nucleus and principal as well as spinal trigeminal nuclei. The motor-coordinating network needs a facilitatory input from the periaqueductal grey of the midbrain and laterally bordering tegmentum in order to be able to produce vocalizations. Voluntary control of vocalization, in contrast to completely innate vocal reactions, such as pain shrieking, needs the intactness of the forebrain. Voluntary control over the initiation and suppression of vocal utterances is carried out by the mediofrontal cortex (including anterior cingulate gyrus and supplementary as well as pre-supplementary motor area). Voluntary control over the acoustic structure of vocalizations is carried out by the motor cortex via pyramidal/corticobulbar as well as extrapyramidal pathways. The most important extrapyramidal pathway seems to be the connection motor cortex-putamen-substantia nigra-parvocellular reticular formation-phonatory motoneurones. The motor cortex depends upon a number of inputs for fulfilling its task. It needs a cerebellar input via the ventrolateral thalamus for allowing a smooth transition between consecutive vocal elements. It needs a proprioceptive input from the phonatory organs via nucl. ventralis posterior medialis thalami, somatosensory cortex and inferior parietal cortex. It needs an input from the ventral premotor and prefrontal cortex, including Broca's area, for motor planning of longer purposeful utterances. And it needs an input from the supplementary and pre-supplementary motor area which give rise to the motor commands executed by the motor cortex.