MEG response to median nerve stimulation correlates with recovery of sensory and motor function after stroke

OBJECTIVE

Hemiparesis due to damage by stroke in primary motor cortex (MI) or its underlying projections presents a problem for functional neuroimaging technologies that attempt to evaluate the neurophysiological basis for restoration of motor function. Traditional assessments of MI function require patients to move their fingers, hands, or limbs, which can be either impossible or markedly compromised after stroke. We recently demonstrated in normal subjects that magnetoencephalography (MEG), a non-invasive neuromagnetic functional imaging technique, detects neuronal response elicited by electrical median nerve stimulation in MI, as well as primary somatosensory cortex (SI). In the present study, we used the MEG response from median nerve stimulation to investigate the recovery of primary motor and somatosensory in acute ischemic stroke patients.

METHODS

Twelve patients with unilateral ischemic strokes that affected sensorimotor functions of their hand were studied in the acute stage (4.4+/-1.2 days, mean+/-SD) and during a 1-month follow-up (38.6+/-5.6 days, except for one patient's follow-up done 6 month after stroke).

RESULTS

Among the multiple cortical sources localized after median nerve stimulation, one source localized to SI and another localized to the vicinity of MI. Changes in the source strengths of the first component post-stimulus of MI and SI correlated with the extent of recovery of sensorimotor functions as determined by neurological exams.

CONCLUSIONS

This study provides a novel way of indirectly assessing MI function using MEG during the acute stroke phase, when many patients often cannot perform motor tasks due to paralysis.

Task relevance enhances early transient and late slow-wave activity of distributed cortical sources

The primary purpose of these studies was to link together concepts related to attention/working memory and feedforward/feedback activity using MEG response profiles obtained in humans. Similar to recent studies of attention in monkeys, we show early "spike-like" activity (<200 ms poststimulus), most likely reflecting an early transient excitatory response mixed with feedback influences, followed by "slow-wave" activity (>200 ms poststimulus) in MEG cortical response profiles evoked by a visual working memory task. We experimentally dissociated the early transient activity from the later sustained activity (predominantly feedback) by conducting an auditory size classification task. Words, representing common objects, evoked activity in occipital cortex (presumably due to imagery) even though visual stimuli were not present in this task. The initial "spike" was absent from the response profile obtained from occipital cortex, leaving only "slow-wave" activity, thereby allowing us to characterize or profile feedback activity in this situation. Attention or task relevance enhanced the initial "spike" and "slow-wave" activity in visually responsive areas. Prefrontal activity, along the superior frontal sulcus, evoked by the working memory task, was active later in time than initial activity in visual cortex and later than the earliest effect of attention modulation in visual cortex.

Sources on the anterior and posterior banks of the central sulcus identified from magnetic somatosensory evoked responses using multistart spatio-temporal localization

A Multi-Start Spatio-Temporal (MSST) multidipole localization algorithm was used to study sources on the anterior and posterior banks of the central sulcus localized from early somatosensory magnetoencephalography (MEG) responses. Electrical stimulation was applied to the right and left median nerves of 8 normal subjects. Two sources, one on the anterior and one on the posterior bank of the central sulcus, were localized from 16 data sets (8 subjects, 2 hemispheres). Compared with the more traditional practice of single-dipole fits to peak latencies, MSST provided more reliable source locations. The temporal dynamics of the anterior and posterior central sulcus sources, obtained using MSST, showed considerable temporal overlap. In some cases, the two sources appeared synchronous. On the other hand, in the traditional single-dipole peak-latency fit approach, there is no time course other than a focal dipole moment activated only at the selected peak latency. The same group of subjects also performed a motor task involving index-finger lifting; the anterior central sulcus source obtained from electrical median nerve stimulation localized to the same or similar region in the primary motor area identified from the finger-lift task. The physiological significance of the anterior central sulcus source is discussed. The findings suggest that one can test the integrity of cortical tissue in the region of primary motor cortex using electrical somatosensory stimulation.

Sources on the anterior and posterior banks of the central sulcus identified from magnetic somatosensory evoked responses using multistart spatio-temporal localization

A Multi-Start Spatio-Temporal (MSST) multidipole localization algorithm was used to study sources on the anterior and posterior banks of the central sulcus localized from early somatosensory magnetoencephalography (MEG) responses. Electrical stimulation was applied to the right and left median nerves of 8 normal subjects. Two sources, one on the anterior and one on the posterior bank of the central sulcus, were localized from 16 data sets (8 subjects, 2 hemispheres). Compared with the more traditional practice of single-dipole fits to peak latencies, MSST provided more reliable source locations. The temporal dynamics of the anterior and posterior central sulcus sources, obtained using MSST, showed considerable temporal overlap. In some cases, the two sources appeared synchronous. On the other hand, in the traditional single-dipole peak-latency fit approach, there is no time course other than a focal dipole moment activated only at the selected peak latency. The same group of subjects also performed a motor task involving index-finger lifting; the anterior central sulcus source obtained from electrical median nerve stimulation localized to the same or similar region in the primary motor area identified from the finger-lift task. The physiological significance of the anterior central sulcus source is discussed. The findings suggest that one can test the integrity of cortical tissue in the region of primary motor cortex using electrical somatosensory stimulation.

Multistart algorithms for MEG empirical data analysis reliably characterize locations and time courses of multiple sources

We applied our newly developed Multistart algorithm (M. Huang et al., 1998, Electroencephalogr. Clin. Neurophysiol. 108, 32-44) to high signal-to-noise ratio (SNR) somatosensory responses and low SNR visual data to demonstrate the reliability of this analysis tool for determining source locations and time courses of empirical multisource neuromagnetic data. This algorithm performs a downhill simplex search hundreds to thousands of times with multiple, randomly selected initial starting parameters from within the head volume, in order to avoid problems of local minima. Two subjects participated in two studies: (1) somatosensory (left and right median nerves were stimulated using a square wave pulse of 0.2 ms duration) and (2) visual (small black and white bull's-eye patterns were presented to central and peripheral locations in four quadrants of the visual field). One subject participated in both of the studies mentioned above and in a third study (i.e., simultaneous somatosensory/visual stimulation). The best-fitting solutions were tightly clustered in high SNR somatosensory data and all dominant regions of activity could be identified in some instances by using a single model order (e.g., six dipoles) applied to a single interval of time (e.g., 15-250 ms) that captured the entire somatosensory response. In low SNR visual data, solutions were obtained from several different model orders and time intervals in order to capture the dominant activity across the entire visual response (e.g. , 60-300 ms). Our results demonstrate that Multistart MEG analysis procedures can localize multiple regions of activity and characterize their time courses in a reliable fashion. Sources for visual data were determined by comparing results across several different models, each of which was based on hundreds to thousands of different fits to the data.

Identification of key gene products required for acquisition of plasmin-like enzymatic activity by group A streptococci

Group A streptococci incubated in human plasma can acquire a plasmin-like enzymatic activity. This process involves at least two bacterial proteins and two human protein cofactors. In this study, the key bacterial proteins were identified by using a series of isogenic mutants of group A isolate, CS101. These studies confirm a key role for the secreted plasminogen activator, streptokinase, and identify the major surface fibrinogen-binding protein as the product of the mrp gene. The requirement for human fibrinogen and plasminogen as key cofactors was also confirmed.

Differential effect of restraint stress on MHC class II expression by murine peritoneal macrophages

The effect of restraint stress on the expression of MHC class II glycoproteins by peritoneal macrophages was evaluated. Restraint suppressed the expression of I-A by macrophages from mice that are susceptible to Mycobacterial infection. In contrast, restraint did not affect I-A expression by macrophages from resistant mice. The suppression of MHC class II expression required at least 8 h of restraint and recovered within 4 h after stress. The amount of restraint necessary to suppress I-A expression also resulted in higher levels of plasma corticosterone. Changes in I-A expression were under circadian rhythm control. The differences in the effect of restraint stress on expression of I-A by peritoneal macrophages from resistant and susceptible mice may, in part, be due to differences in the effect of corticosterone in MHC class II expression.

Restraint stress-induced suppression of major histocompatibility complex class II expression by murine peritoneal macrophages

The macrophage plays a central role in the development of immune responses. Macrophages take up and process antigen which is presented to antigen-responsive T lymphocytes in association with major histocompatibility complex class II (Ia) glycoproteins. We have investigated the effect of restraint stress on Ia expression by murine peritoneal macrophages. Stress resulted in a suppression of Ia expression which coincided with an increase in plasma corticosterone levels. In vitro experiments indicate that suppression of Ia expression can occur within 2 h after exposure to corticosterone. The suppression of this important aspect of macrophage function by stressors has important implications regarding the possible immunosuppressive effects of stress on the response of lymphocytes to antigens that depend on intact macrophage function.