Feasibility and optimal choice of stimulation parameters for supramaximal stimulation of motor evoked potentials

PURPOSE

The aim was to investigate the feasibility and optimal stimulation parameters for supramaximal stimulation of muscle recorded transcranial electrical stimulation motor evoked potentials (mTc-MEP).

METHODS

Forty-seven consecutive patients that underwent scoliosis surgery were included. First, the feasibility of supramaximal stimulation was assessed for two settings (setting 1: pulse duration 0.075ms, interstimulus interval (ISI) 1.5ms; setting 2: pulse duration 0.300ms, ISI 3ms). Thereafter, three mTc-MEP parameters were considered for both settings; (1) elicitability, (2) amplitude, and (3) if supramaximal stimulation was achieved with ≥ 20 V below maximum output. Finally, ISIs (1ms-4ms) were optimized for setting 1.

RESULTS

Nine patients (19.15%) were excluded. Of the remaining patients, supramaximal stimulation was achieved in all patients for setting 1, and in 26 (68.42%) for setting 2. In one patient, mTc-MEPs were elicitable in more muscles for setting (1) Amplitudes were not significantly different. Stimulation voltage could be increased ≥ 20 V in all 38 patients for setting 1 and in 10 (38.46%) for setting (2) Optimal ISI's differed widely.

CONCLUSION

We recommend using setting 1 when monitoring mTc-MEPs with supramaximal stimulation, after which an individualized ISI optimization can be performed. Moreover, when using supramaximal stimulation, short ISI's (i.e. 1ms or 1.5ms) can be the optimal ISI for obtaining the highest mTc-MEP amplitude.

Fast acquisition of resting motor threshold with a stimulus-response curve - Possibility or hazard for transcranial magnetic stimulation applications?

Objective

Previous research has suggested that transcranial magnetic stimulation (TMS) related cortical excitability measures could be estimated quickly using stimulus-response curves with short interstimulus intervals (ISIs). Here we evaluated the resting motor threshold (rMT) estimated with these curves.

Methods

Stimulus-response curves were measured with three ISIs: 1.2-2 s, 2-3 s, and 3-4 s. Each curve was formed with 108 stimuli using stimulation intensities ranging from 0.75 to 1.25 times the rMT_guess, which was estimated based on motor evoked potential (MEP) amplitudes of three scout responses.

Results

The ISI did not affect the rMT estimated from the curves (F = 0.235, p = 0.683) or single-trial MEP amplitudes at the group level (F = 0.90, p = 0.405), but a significant subject by ISI interaction (F = 3.64; p < 0.001) was detected in MEP amplitudes. No trend was observed which ISI was most excitable, as it varied between subjects.

Conclusions

At the group level, the stimulus-response curves are unaffected by the short ISI. At the individual level, these curves are highly affected by the ISI.

Significance

Estimating rMT using stimulus-response curves with short ISIs impacts the rMT estimate and should be avoided in clinical and research TMS applications.

A stimulus rate that is not influenced by homosynaptic post-activation depression in chronic stroke

PURPOSE

To determine a stimulus rate that is not influenced by homosynaptic post-activation depression for H-reflex studies in patients with chronic spasticity.

MATERIALS AND METHODS

A cohort of 15 chronic stroke patients with soleus spasticity who received inpatient treatment at our rehabilitation centre participated in this study. The effect of stimulus frequency related depression on H-reflex size was tested using four different stimulus rates (0.1, 0.2, 0.3 and 1 Hz). The affected sides stibial nerve was stimulated by a bipolar electrode. The H-reflex was recorded from the affected sideed sidee sidehe affected smine stimulus frequency related depression of H-reflex size, amplitude of the first H-reflex response (H₁) was used as control and amplitude of the second H-reflex response (H₂) as test.

RESULTS

H₂ amplitude for frequency of 1 Hz, 0.3 Hz, 0.2 Hz and 0.1 Hz were 74.3, 84.1, 85.5 and 92.7% of H₁, respectively. Depression of H₂ amplitude was statistically significant for 1 Hz, 0.3 Hz and 0.2 Hz (p < 0.001, p = 0.002, p = 0.024, respectively).

CONCLUSIONS

Higher frequency stimulation of Ia afferents than 0.1 Hz induced a stimulus frequency-related depression of H-reflex size in patients with chronic spasticity. The optimal stimulus rate for H-reflex was found to be 0.1 Hz.

Cognitive task modality influences postural control during quiet standing in healthy older adults

BACKGROUND

The interstimulus interval of a cognitive task was found to have a limited effect on postural control in young adults, while visual cognitive tasks were found to improve stability compared to auditory tasks. It is of interest to investigate whether postural control in healthy older adults is sensitive to these types of cognitive task manipulations.

AIMS

The objectives of the present experiment were to evaluate the impact of interstimulus interval and modality of a continuous cognitive task on postural control in healthy older adults.

METHODS

Fifteen healthy older adults (70 ± 3.2 years, 3 male) were asked to stand with feet together on a force platform while performing auditory and visual cognitive tasks performed with interstimulus intervals of 2 and 5 s.

RESULTS

Visual tasks led to reductions in sway area and sway variability in the anterior-posterior direction compared to auditory tasks (ps ≤ 0.05). The interstimulus interval did not lead to a change in sway, except for a small change in the medial-lateral direction for the 2-s interval compared to the 5-s interval (p = 0.05).

DISCUSSION AND CONCLUSIONS

Results suggest that the interstimulus interval had a very limited effect on postural sway. The modality of the cognitive task had a greater effect on postural sway, as visual cognitive tasks yielded smaller sway area and anterior-posterior sway variability than auditory conditions. Visual stimuli may have acted as an anchor, yielding reduced sway.

Face identity is encoded in the duration of N170 adaptation

Previous studies assessing the involvement of the face-sensitive N170 component of the event-related potential (ERP) in the processing of face identity have shown controversial results when assessing N170 amplitude in repetition suppression (RS) designs. On the other hand, N170 adaptation is robustly associated with the inter-stimulus interval (ISI) between immediate face repetitions. Interestingly, interactions of face identity and ISI could provide valuable information on early encoding of face identity, but have not been investigated so far. We employed a repetition suppression paradigm using identical and non-identical repetitions as well as parametrically varied ISIs between 500 msec and 2,000 msec in 27 healthy subjects to investigate N170 adaptation effects. Both face identity and varying ISIs significantly influenced N170 adaptation effects, albeit with small effects sizes. Most importantly, however, face identity and ISIs strongly interacted with rapid N170 amplitude recovery in non-identical trials, but sustained N170 adaptation in identical trials. We excluded low-level sensory contributions to the N170 adaptation effect by analyzing the P1 component and by running an additional experiment employing different stimulus sizes. This specific result strongly argues in favor of neuronal sensitivity to face identity, which is primarily mirrored in the N170 temporal decay function that essentially differentiates identical and non-identical face trials. In general, taking advantage of the temporal dimension of adaptation processes, i.e., their decay over time, provides additional dissections of neuronal function into feature-specific selectivity versus non-selectivity.