Different descending pathways mediate early and late portions of lower limb responses to transcranial magnetic stimulation

While recent studies in non-human primates have provided evidence that transcranial magnetic stimulation (TMS) activates cells within the reticular formation, it remains unclear whether descending brainstem projections contribute to the generation of TMS-induced motor evoked potentials (MEPs) in skeletal muscles. We compared MEPs in muscles with extensive direct corticomotoneuronal input (first dorsal interosseous) versus a prominent role in postural control (gastrocnemius) to determine whether the amplitude of early and late MEPs were differentially modulated by cortical suppression. Suprathreshold TMS was applied with and without a preceding suprathreshold TMS pulse at two interstimulus intervals (50 and 80 ms). H-reflexes in target muscles were also tested with and without TMS conditioning. Early and late gastrocnemius MEPs were differentially modulated by cortical inhibition, the amplitude of the early MEP being significantly reduced by cortical suppression and the late MEP facilitated. The amplitude of H-reflexes in the gastrocnemius was reduced within the cortical silent period. Early MEPs in the first dorsal interosseous were also reduced during the silent period, but late MEPs unaffected. Independent modulation of early and late MEPs in the gastrocnemius muscle supports the idea that the MEP is generated by multiple descending pathways. Suppression of the early MEP is consistent with transmission along the fast-conducting corticospinal tract, whereas facilitation of the late MEP suggests transmission along a corticofugal, potentially cortico-reticulospinal, pathway. Accordingly, differences in late MEP modulation between the first dorsal interosseous and gastrocnemius reflect an increased role of corticofugal pathways in the control of postural muscles.

Corticospinal Modulation of Precision Movements

Recently we demonstrated a critical role for temporal coding of corticospinal activity in a prehension movement requiring precise forelimb control. Learning of precision isometric pull drives large-scale remodeling of corticospinal motor networks. Optogenetic modulation of corticospinal activity and full transection of the corticospinal tract disrupted critical functions of the network in expert animals resulting in impaired modulation of precise movements. In contrast, we observed more widespread corticospinal co-activation and limited temporal coding on a similar, yet more simplistic prehension task, adaptive isometric pull. Disrupting corticospinal neuron activity had much more limited effects on adaptive isometric pull, which was found to be corticospinal independent by transection of the corticospinal tract. Here we discuss these results in context of known roles for corticospinal and corticostriatal neurons in motor control, as well as some of the questions our study raised.

The Corticospinal System and Amyotrophic Lateral Sclerosis: IFCN handbook chapter

Corticospinal neurons located in motor areas of the cerebral neocortex project corticospinal axons which synapse with the spinal network; a parallel corticobulbar system projects to the cranial motor network and to brainstem motor pathways. The primate corticospinal system has a widespread cortical origin and an extensive range of different fibre diameters, including thick, fast-conducting axons. Direct cortico-motoneuronal (CM) projections from the motor cortex to arm and hand alpha motoneurons are a recent evolutionary feature, that is well developed in dexterous primates and particularly in humans. Many of these projections originate from the caudal subdivision of area 4 ('new' M1: primary motor cortex). They arise from corticospinal neurons of varied soma size, including those with fast- and relatively slow-conducting axons. This CM system has been shown to be involved in the control of skilled movements, carried out with fractionation of the distal extremities and at low force levels. During movement, corticospinal neurons are activated quite differently from 'lower' motoneurons, and there is no simple or fixed functional relationship between a so-called 'upper' motoneuron and its target lower motoneuron. There are key differences in the organisation and function of the corticospinal and CM system in primates versus non-primates, such as rodents. These differences need to be recognized when making the choice of animal model for understanding disorders such as amyotrophic lateral sclerosis (ALS). In this neurodegenerative brain disease there is a selective loss of fast-conducting corticospinal axons, and their synaptic connections, and this is reflected in responses to non-invasive cortical stimuli and measures of cortico-muscular coherence. The loss of CM connections influencing distal limb muscles results in a differential loss of muscle strength or 'split-hand' phenotype. Importantly, there is also a unique impairment in the coordination of skilled hand tasks that require fractionation of digit movement. Scores on validated tests of skilled hand function could be used to assess disease progression.

Serotonergic and noradrenergic contributions to motor cortical and spinal motoneuronal excitability in humans

Animal models indicate that motor behaviour is shaped by monoamine neuromodulators released diffusely throughout the brain and spinal cord. As an alternative to conducting a single study to explore the effects of neuromodulators on the human motor system, we have identified and collated human experiments investigating motor effects of well-characterised drugs that act on serotonergic and noradrenergic networks. In doing so, we present strong neuropharmacology evidence that human motor pathways are affected by neuromodulators across both healthy and clinical populations, insight that cannot be determined from a single reductionist experiment. We have focused our review on the effects that monoaminergic drugs have on muscle responses to non-invasive stimulation of the motor cortex and peripheral nerves, and other closely related tests of motoneuron excitability, and discuss how these measurement techniques elucidate the effects of neuromodulators at motor cortical and spinal motoneuronal levels. Although there is some heterogeneity in study methods, we find drugs acting to enhance extracellular concentrations of serotonin tend to reduce the excitability of the human motor cortex, and enhanced extracellular concentrations of noradrenaline increases motor cortical excitability by enhancing intracortical facilitation and reducing inhibition. Both monoamines tend to enhance the excitability of spinal motoneurons. Overall, this review details the importance of neuromodulators for the output of human motor pathways and suggests that commonly prescribed monoaminergic drugs target the motor system in addition to their typical psychiatric/neurological indications.

Resolving equivocal gain modulation of corticospinal excitability

The ratio between the input and output of neuronal populations, usually referred to as gain modulation, is rhythmically modulated along the oscillatory cycle. Previous research on spinal neurons, however, revealed contradictory findings: both uni- and bimodal patterns of increased responsiveness for synaptic input have been proposed for the oscillatory beta rhythm. In this study, we compared previous approaches of phase estimation directly on simulated data and empirically tested the corresponding predictions in healthy males and females. We applied single-pulse transcranial magnetic stimulation over the primary motor cortex at rest, and assessed the spinal output generated by this input. Specifically, the peak-to-peak amplitude of the motor evoked potential in the contralateral forearm was estimated as a function of the EMG phase at which the stimulus was applied. The findings indicated that human spinal neurons adhere to a unimodal pattern of increased responsiveness, and suggest that the rising phase of the upper beta band maximizes gain modulation. Importantly, a bimodal pattern of increased responsiveness was shown to result in an artifact during data analysis and filtering. This observation of invalid preprocessing could be generalized to other frequency bands (i.e., delta, theta, alpha, and gamma), different task conditions (i.e., voluntary muscle contraction), and EEG-based phase estimations. Appropriate analysis algorithms, such as broad-band filtering, enable us to accurately determine gain modulation of neuronal populations and to avoid erroneous phase estimations. This may facilitate novel phase-specific interventions for targeted neuromodulation.

Induction of interhemispheric facilitation by short bursts of transcranial alternating current stimulation

Interhemispheric facilitation (IHF) describes potentiation of motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) over primary motor cortex (M1), when they are preceded (3-6 ms) by conditioning TMS below motor threshold (MT) delivered over the opposite M1. This effect is however obtained only when the conditioning stimulation is sufficiently circumscribed. In paired associative protocols, (500 ms) bursts of 140 Hz transcranial alternating current stimulation (tACS) interact with the state of neural circuits in the opposite hemisphere in a similar manner to sub-threshold TMS. We hypothesised that tACS applied over M1 would elevate the amplitudes of MEPs elicited by suprathreshold TMS applied 6 ms later over the opposite M1. Thirty healthy right-handed participants were tested. In a control condition, MEPs were recorded in right flexor carpi radialis (rFCR) following 120% resting MT TMS over left M1. In 11 experimental conditions, 1 mA (peak-to-peak) 140 Hz (30, 100, 500 ms) or 670 Hz (6, 12, 100, 500 ms) tACS, or 100-640 Hz (6, 12, 100, 500 ms) transcranial random noise stimulation (tRNS), was delivered over right M1, 6 ms in advance of the TMS. IHF was obtained by conditioning with 30 ms (but not 100 or 500 ms) 140 Hz tACS. The magnitude of IHF (12% increase; d = 0.56 (0.21-0.98)) was within the range reported for dual-coil TMS studies. Conditioning by 670 Hz tACS or tRNS had no effect. Our findings indicate that short bursts of 140 Hz tACS, applied over M1, have distributed effects similar to those of subthreshold TMS.

Corticospinal excitability is highest at the early rising phase of sensorimotor µ-rhythm

Alpha oscillations are thought to reflect alternating cortical states of excitation and inhibition. Studies of perceptual thresholds and evoked potentials have shown the scalp EEG negative phase of the oscillation to correspond to a short-lasting low-threshold and high-excitability state of underlying visual, somatosensory, and primary motor cortex. The negative peak of the oscillation is assumed to correspond to the state of highest excitability based on biophysical considerations and considerable effort has been made to improve the extraction of a predictive signal by individually optimizing EEG montages. Here, we investigate whether it is the negative peak of sensorimotor µ-rhythm that corresponds to the highest corticospinal excitability, and whether this is consistent between individuals. In 52 adult participants, a standard 5-channel surface Laplacian EEG montage was used to extract sensorimotor µ-rhythm during transcranial magnetic stimulation (TMS) of primary motor cortex. Post-hoc trials were sorted from 800 TMS-evoked motor potentials (MEPs) according to the pre-stimulus EEG (estimated instantaneous phase) and MEP amplitude (as an index of corticospinal excitability). Different preprocessing transformations designed to improve the accuracy by which µ-alpha phase predicts excitability were also tested. By fitting a sinusoid to the MEP amplitudes, sorted according to pre-stimulus EEG-phase, we found that excitability was highest during the early rising phase, at a significant delay with respect to the negative peak by on average 45° or 10 ms. The individual phase of highest excitability was consistent across study participants and unaffected by two different EEG-cleaning methods that utilize 64 channels to improve signal quality by compensating for individual noise level and channel covariance. Personalized transformations of the montage did not yield better prediction of excitability from µ-alpha phase. The relationship between instantaneous phase of a brain oscillation and fluctuating cortical excitability appears to be more complex than previously hypothesized. In TMS of motor cortex, a standard surface Laplacian 5-channel EEG montage is effective in extracting a predictive signal and the phase corresponding to the highest excitability appears to be consistent between individuals. This is an encouraging result with respect to the clinical potential of therapeutic personalized brain interventions in the motor system. However, it remains to be investigated, whether similar results can be obtained for other brain areas and brain oscillations targeted with EEG and TMS.

Postural support requirements preferentially modulate late components of the gastrocnemius response to transcranial magnetic stimulation

Mounting evidence suggests that motor evoked potentials (MEPs) recorded in upper limb muscles with postural support roles following transcranial magnetic stimulation receive contributions from both corticospinal and non-corticospinal descending pathways. We tested the hypothesis that neural structures responsible for regulating upright balance are involved in transmitting late portions of TMS-induced MEPs in a lower limb muscle. MEPs were recorded in the medial gastrocnemius muscles of each leg, while participants supported their upright posture in five postural conditions that required different levels of support from the target muscles. We observed that early and late portions of the MEP were modulated independently, with early MEP amplitude being reduced when high levels of postural support were required from a target muscle. Independent modulation of early and late MEPs by altered postural demand suggests largely separable transmission of each part of the MEP. The early component of the MEP is likely generated by fast-conducting corticospinal pathways, whereas the later component may be primarily transmitted along a polysynaptic cortico-reticulospinal pathway.

Mapping the human corticoreticular pathway with multimodal delineation of the gigantocellular reticular nucleus and high-resolution diffusion tractography

The corticoreticular pathway (CRP) is a major motor tract that transmits cortical input to the reticular formation motor nuclei and may be an important mediator of motor recovery after central nervous system damage. However, its cortical origins, trajectory and laterality are incompletely understood in humans. This study aimed to map the human CRP and generate an average CRP template in standard MRI space. Following recently established guidelines, we manually delineated the primary reticular formation motor nucleus (gigantocellular reticular nucleus [GRN]) using several group-mean MRI contrasts from the Human Connectome Project (HCP). CRP tractography was then performed with HCP diffusion-weighted MRI data (N = 1065) by selecting diffusion streamlines that reached both the cortex and GRN. Corticospinal tract (CST) tractography was also performed for comparison. Results suggest that the human CRP has widespread origins, which overlap with the CST across most of the motor cortex and include additional exclusive inputs from the medial and anterior prefrontal cortices. The estimated CRP projected through the anterior and posterior limbs of the internal capsule before partially decussating in the midbrain tegmentum and converging bilaterally on the pontomedullary reticular formation. Thus, the CRP trajectory appears to partially overlap the CST, while being more distributed and anteromedial to the CST in the cerebrum before moving posterior to the CST in the brainstem. These findings have important implications for neurophysiologic testing, cortical stimulation and movement recovery after brain lesions. We expect that our GRN and tract maps will also facilitate future CRP research.

Viral expression of constitutively active AKT3 induces CST axonal sprouting and regeneration, but also promotes seizures

Increasing the intrinsic growth potential of neurons after injury has repeatedly been shown to promote some level of axonal regeneration in rodent models. One of the most studied pathways involves the activation of the PI3K/AKT/mTOR pathways, primarily by reducing the levels of PTEN, a negative regulator of PI3K. Likewise, activation of signal transducer and activator of transcription 3 (STAT3) has previously been shown to boost axonal regeneration and sprouting within the injured nervous system. Here, we examined the regeneration of the corticospinal tract (CST) after cortical expression of constitutively active (ca) Akt3 and STAT3, both separately and in combination. Overexpression of caAkt3 induced regeneration of CST axons past the injury site independent of caSTAT3 overexpression. STAT3 demonstrated improved axon sprouting compared to controls and contributed to a synergistic improvement in effects when combined with Akt3 but failed to promote axonal regeneration as an individual therapy. Despite showing impressive axonal regeneration, animals expressing Akt3 failed to show any functional improvement and deteriorated with time. During this period, we observed progressive Akt3 dose-dependent increase in behavioral seizures. Histology revealed increased phosphorylation of ribosomal S6 protein within the unilateral cortex, increased neuronal size, microglia activation and hemispheric enlargement (hemimegalencephaly).

"Fully automated segmentation of the corticospinal tract using the TractSeg algorithm in patients with brain tumors"

OBJECTIVE

Tractography has been used to define the presurgical location of white matter tracts, but this is subjective and time-intensive, making incorporation to imaging workflow at scale problematic. The objective is to validate a fully automated pipeline using the TractSeg algorithm (Wasserthal et al. NeuroImage 2018;183:239-253) to segment the corticospinal tract in patients with brain tumors adjacent to the corticospinal tract.

METHODS

The process of importing a structural MPRAGE sequence and raw diffusion weighted images from PACS, executing the TractSeg algorithm, overlaying the resulting bilateral corticospinal tracts on the MPRAGE image, and exporting this composite image to PACS was automated. This procedure was used to segment the corticospinal tract in 28 patients with brain masses adjacent to or displacing the corticospinal tract. These segmentations were compared with both manual deterministic tractography performed with DSI Studio using seeds placed in the pons and an automated tractography method in DSI Studio.

RESULTS

The automated algorithm was able to segment the bilateral corticospinal tracts in all 28 patients whereas the manual reference method and DSI Studio based automated tractography were unsuccessful in 2 and 1 patients, respectively. In all cases, the TractSeg segmentations very closely matched the manual segmentations. Also, TractSeg appeared to include larger portions of the lateral corticospinal tract fibers than the other 2 methods.

CONCLUSION

The TractSeg algorithm demonstrated robust performance in segmenting the corticospinal tract in patients with brain tumors adjacent to this tract. The algorithm is fast to perform and has great potential for optimizing and streamlining neurosurgical planning.

State-of-the-art review: spinal and supraspinal responses to muscle potentiation in humans

Post-activation potentiation (PAP), described as a muscular phenomenon, refers to the enhancement of contractile properties following a voluntary or electrically stimulated short duration (< 10 s) high-intensity contraction. Mechanistic factors and subsequent effects on voluntary performance have been well documented. Associations between neural activation and PAP, however, are less understood and systematically have not been explored. Thus, the aim is to critically summarize the current understanding of PAP regarding the motor pathway from the corticospinal tract to spinal level factors including the H-reflex and motor unit activation. This review highlights aspects for further investigation by providing an integrative summary of the relationship between PAP and neural control. Contractile history affects neural control in subsequent contractions, (e.g. fatiguing tasks), however, by contrast acute contractile enhancement due to PAP in relation to neural responses are not well-studied. From the limited number of investigations, motor unit discharge rates are reduced subsequent to PAP and, although less consistently reported, generally H-reflexes are depressed. Additionally, corticomedullary evoked potentials are depressed and the cortical silent period is elongated. Thus, overall there is a depression of spinal and supraspinal responses following PAP. Although specific factors responsible and their pathways are unclear, this down-regulation may occur to conserve neural activation when muscle contraction is more responsive, and concurrently a strategy used to delay neuromuscular fatigue. Indeed, the co-existence of PAP and fatigue is not a novel concept, but the interactions between PAP and neural responses are not understood and likely are more than coincidental.

A Bayesian approach to analysing cortico-cortical associative stimulation induced increases in the excitability of corticospinal projections in humans

Repeated pairing of transcranial magnetic stimulation (TMS) over left and right primary motor cortex (M1), at intensities sufficient to generate descending volleys, produces sustained increases in corticospinal excitability. In other paired associative stimulation (PAS) protocols, in which peripheral afferent stimulation is the first element, changes in corticospinal excitability achieved when the second stimulus consists of brief bursts of transcranial alternating current stimulation (tACS), are comparable to those obtained if TMS is used instead (McNickle and Carson 2015). The present aim was to determine whether associative effects are induced when the first stimulus of a cortico-cortical pair is tACS, or alternatively subthreshold TMS. Bursts of tACS (500 ms; 140 Hz; 1 mA) were associated (180 stimulus pairs) with single magnetic stimuli (120% resting motor threshold rMT) delivered over the opposite (left) M1. The tACS ended 6 ms prior to the TMS. In a separate condition, TMS (55% rMT) was delivered to right M1 6 ms before (120% rMT) TMS was applied over left M1. In a sham condition, TMS (120% rMT) was delivered to left M1 only. The limitations of null hypothesis significance testing are well documented. We therefore employed Bayes factors to assess evidence in support of experimental hypotheses—defined precisely in terms of predicted effect sizes, that these two novel variants of PAS increase corticospinal excitability. Although both interventions induced sustained (~ 20–30 min) increases in corticospinal excitability, the evidence in support of the experimental hypotheses (over specified alternatives) was generally greater for the paired TMS-TMS than the tACS-TMS conditions.

Stratifying chronic stroke patients based on the influence of contralesional motor cortices: An inter-hemispheric inhibition study

OBJECTIVE

A recent "bimodal-balance recovery" model suggests that contralesional influence varies based on the amount of ipsilesional reserve: inhibitory when there is a large reserve, but supportive when there is a low reserve. Here, we investigated the relationships between contralesional influence (inter-hemispheric inhibition, IHI) and ipsilesional reserve (corticospinal damage/impairment), and also defined a criterion separating subgroups based on the relationships.

METHODS

Twenty-four patients underwent assessment of IHI using Transcranial Magnetic Stimulation (ipsilateral silent period method), motor impairment using Upper Extremity Fugl-Meyer (UEFM), and corticospinal damage using Diffusion Tensor Imaging and active motor threshold. Assessments of UEFM and IHI were repeated after 5-week rehabilitation (n = 21).

RESULTS

Relationship between IHI and baseline UEFM was quadratic with criterion at UEFM 43 (95%conference interval: 40-46). Patients less impaired than UEFM = 43 showed stronger IHI with more impairment, whereas patients more impaired than UEFM = 43 showed lower IHI with more impairment. Of those made clinically-meaningful functional gains in rehabilitation (n = 14), more-impaired patients showed further IHI reduction.

CONCLUSIONS

A criterion impairment-level can be derived to stratify patient-subgroups based on the bimodal influence of contralesional cortex. Contralesional influence also evolves differently across subgroups following rehabilitation.

SIGNIFICANCE

The criterion may be used to stratify patients to design targeted, precision treatments.

Independent replication of motor cortex and cervical spinal cord electrical stimulation to promote forelimb motor function after spinal cord injury in rats

Cervical spinal cord injury (SCI) impairs arm and hand function largely by interrupting descending tracts. Most SCI spare some axons at the lesion, including the corticospinal tract (CST), which is critical for voluntary movement. We targeted descending motor connections with paired electrical stimulation of motor cortex and cervical spinal cord in the rat. We sought to replicate the previously published effects of intermittent theta burst stimulation of forelimb motor cortex combined with trans-spinal direct current stimulation placed on the skin over the neck to target the cervical enlargement. We hypothesized that paired stimulation would improve performance in skilled walking and food manipulation (IBB) tasks. Rats received a moderate C4 spinal cord contusion injury (200 kDynes), which ablates the main CST. They were randomized to receive paired stimulation for 10 consecutive days starting 11 days after injury, or no stimulation. Behavior was assessed weekly from weeks 4-7 after injury, and then CST axons were traced. Rats with paired cortical and spinal stimulation achieved significantly better forelimb motor function recovery, as measured by fewer stepping errors on the horizontal ladder task (34 ± 9% in stimulation group vs. 51 ± 18% in control, p = .013) and higher scores on the food manipulation task (IBB, 0-9 score; 7.2 ± 0.8 in stimulated rats vs. 5.2 ± 2.6 in controls, p = .025). The effect size for both tasks was large (Cohen's d = 1.0 and 0.92, respectively). The CST axon length in the cervical spinal cord did not differ significantly between the groups, but there was denser and broader ipsilateral axons distribution distal to the spinal cord injury. The large behavioral effect and replication in an independent laboratory validate this approach, which will be trialed in cats before being tested in people using non-invasive methods.

Diffusion MRI parameters of corpus callosum and corticospinal tract in neonates: Comparison between region-of-interest and whole tract averaged measurements

PURPOSE

Measures of white matter (WM) microstructure inferred from diffusion magnetic resonance imaging (dMRI) are useful for studying brain development. There is uncertainty about agreement between FA and MD values obtained from region-of-interest (ROI) versus whole tract approaches. We investigated agreement between dMRI measures using ROI and Probabilistic Neighbourhood Tractography (PNT) in genu of corpus callosum (gCC) and corticospinal tracts (CST).

MATERIALS AND METHODS

81 neonates underwent 64 direction DTI at term equivalent age. FA and MD values were extracted from a 8 mm³ ROI placed within the gCC, right and left posterior limbs of internal capsule. PNT was used to segment gCC and CSTs to calculate whole tract-averaged FA and MD. Agreement between values obtained by each method was compared using Bland-Altman statistics and Pearson's correlation.

RESULTS

Across the 3 tracts the mean difference in FA measured by PNT and ROI ranged between 0.13 and 0.17, and the 95% limits of agreement did not include the possibility of no difference. For MD, the mean difference in values obtained from PNT and ROI ranged between 0.101 and 0.184 mm²/s × 10^-3 mm²/s: the mean difference in gCC was 0.101 × 10^-3 mm²/s with 95% limits of agreement that included the possibility of no difference, but there was significant disagreement in MD values measured in the CSTs.

CONCLUSION

Agreement between dMRI measures of neonatal WM microstructure calculated from ROI and whole tract averaged methods is weak. ROI approaches may not provide sufficient representation of tract microstructure at the level of neural systems in newborns.

Motor transfer from the corticospinal to the corticobulbar pathway

There are multiple descending neural pathways, including the corticospinal pathway (CS) and the corticobulbar pathway (CB). The corticospinal pathway has been shown to exhibit within-pathway (CS-to-CS) motor transfer. However, motor transfer across each pathway (CS-to-CB or CB-to-CS) has yet to be studied in depth. The aim of the present study was to examine the effects of cross-pathway motor transfer between the ankle (CS) and tongue (CB) after training with a ballistic goal-directed motor task. Twelve healthy participants were recruited for this two-day experimental study. Six participants performed a ballistic goal-directed task with their ankle on Day 1 (ankle dorsiflexion), then tongue on Day 2 (elevate tongue against IOPI). The other 6 participants performed the same task with their tongue on Day 1, then ankle on Day 2. Both the ankle and tongue tasks (50 trials each) required matching force and time to a visual target. Our findings indicate that participants who underwent ankle training on Day 1 exhibited decreased tongue force error on Day 2 compared with participants who completed the tongue training on Day 1, with no prior ankle training (p = 0.02) (i.e. greater accuracy). This finding suggests that cross-pathway transfer from the corticospinal pathway to the corticobulbar pathway occurred with respect to force error. In other words, training of the ankle (CS) translated to improved training performance of the tongue (CB) through a reduction in force error. However, the reverse was not true - training the tongue did not elicit improved performance of the ankle. Nonetheless, if training with the corticospinal pathway can lead to improved corticobulbar pathway functioning, incorporating multi-pathway rehabilitation techniques might be valuable for clinicians across medical disciplines.

Potentiating paired corticospinal-motoneuronal plasticity after spinal cord injury

BACKGROUND

Paired corticospinal-motoneuronal stimulation (PCMS) increases corticospinal transmission in humans with chronic incomplete spinal cord injury (SCI).

OBJECTIVE/HYPOTHESIS

Here, we examine whether increases in the excitability of spinal motoneurons, by performing voluntary activity, could potentiate PCMS effects on corticospinal transmission.

METHODS

During PCMS, we used 100 pairs of stimuli where corticospinal volleys evoked by transcranial magnetic stimulation (TMS) over the hand representation of the primary motor cortex were timed to arrive at corticospinal-motoneuronal synapses of the first dorsal interosseous (FDI) muscle ∼1-2 ms before antidromic potentials were elicited in motoneurons by electrical stimulation of the ulnar nerve. PCMS was applied at rest (PCMS_rest) and during a small level of isometric index finger abduction (PCMS_active) on separate days. Motor evoked potentials (MEPs) elicited by TMS and electrical stimulation were measured in the FDI muscle before and after each protocol in humans with and without (controls) chronic cervical SCI.

RESULTS

We found in control participants that MEPs elicited by TMS and electrical stimulation increased to a similar extent after both PCMS protocols for ∼30 min. Whereas, in humans with SCI, MEPs elicited by TMS and electrical stimulation increased to a larger extent after PCMS_active compared with PCMS_rest. Importantly, SCI participants who did not respond to PCMS_rest responded after PCMS_active and those who responded to both protocols showed larger increments in corticospinal transmission after PCMS_active.

CONCLUSIONS

Our findings suggest that muscle contraction during PCMS potentiates corticospinal transmission. PCMS applied during voluntary activity may represent a strategy to boost spinal plasticity after SCI.

The ipsilateral corticospinal responses to cross-education are dependent upon the motor-training intervention

This study aimed to identify the ipsilateral corticospinal responses of the contralateral limb following different types of unilateral motor-training. Three groups performing unilateral slow-paced strength training (SPST), non-paced strength training (NPST) or visuomotor skill training (VT) were compared to a control group. It was hypothesised that 4 weeks of unilateral SPST and VT, but not NPST, would increase ipsilateral corticospinal excitability (CSE) and reduce short-interval cortical inhibition (SICI), resulting in greater performance gains of the untrained limb. Tracking error of the untrained limb reduced by 29 and 41% following 2 and 4 weeks of VT. Strength of the untrained limb increased by 8 and 16% following 2 and 4 weeks of SPST and by 6 and 13% following NPST. There was no difference in cross-education of strength or tracking error. For the trained limb, SPST and NPST increased strength (28 and 26%), and VT improved by 47 and 58%. SPST and VT increased ipsilateral CSE by 89 and 71% at 2 weeks. Ipsilateral CSE increased 105 and 81% at 4 weeks following SPST and VT. The NPST group and control group showed no changes at 2 and 4 weeks. SPST and VT reduced ipsilateral SICI by 45 and 47% at 2 weeks; at 4 weeks, SPST and VT reduced SICI by 48 and 38%. The ipsilateral corticospinal responses are determined by the type of motor-training. There were no differences in motor performance between SPST, NPST and VT. The data suggests that the corticospinal responses to cross-education are different and determined by the type of motor-training.

Motor-evoked potentials reveal functional differences between dominant and non-dominant motor cortices during response preparation

Transcranial magnetic stimulation (TMS) of the motor cortex produces motor-evoked potentials (MEPs) in contralateral muscles. The amplitude of these MEPs can be used to measure the excitability of the corticospinal tract during motor planning. In two experiments, we investigated learning-related changes in corticospinal excitability as subjects prepared to respond in a choice reaction-time task. Subjects responded with their left or right hand to a left or right arrow, and on some trials the arrow was immediately preceded by a warning cue that signaled which response would be required. TMS was applied to the motor cortex during the warning cues, and MEPs were measured in the dominant or non-dominant hand. We observed changes in corticospinal excitability during the warning cue, but these depended on which hand the subject was preparing to respond with, and how experienced they were with the task. When subjects prepared to respond with the non-dominant hand, excitability increased in the non-dominant hemisphere and decreased in the dominant hemisphere. These changes became stronger with task experience, and were accompanied by behavioral improvements in the task. When subjects were preparing a dominant-hand response, the non-dominant hemisphere was suppressed, but this effect disappeared as subjects gained experience with the task. There were no changes in the dominant hemisphere before dominant-hand responses. We conclude that preparing to respond with the non-dominant hand involves temporarily reversing an asymmetry in excitability that normally favors the dominant hemisphere, and that this pattern is enhanced by learning during the task.

Referent control of the orientation of posture and movement in the gravitational field

This study addresses the question of how posture and movement are oriented with respect to the direction of gravity. It is suggested that neural control levels coordinate spatial thresholds at which multiple muscles begin to be activated to specify a referent body orientation (RO) at which muscle activity is minimized. Under the influence of gravity, the body is deflected from the RO to an actual orientation (AO) until the emerging muscle activity and forces begin to balance gravitational forces and maintain body stability. We assumed that (1) during quiet standing on differently tilted surfaces, the same RO and thus AO can be maintained by adjusting activation thresholds of ankle muscles according to the surface tilt angle; (2) intentional forward body leaning results from monotonic ramp-and-hold shifts in the RO; (3) rhythmic oscillation of the RO about the ankle joints during standing results in body swaying. At certain sway phases, the AO and RO may transiently overlap, resulting in minima in the activity of multiple muscles across the body. EMG kinematic patterns of the 3 tasks were recorded and explained based on the RO concept that implies that these patterns emerge due to referent control without being pre-programmed. We also confirmed the predicted occurrence of minima in the activity of multiple muscles at specific body configurations during swaying. Results re-affirm previous rejections of model-based computational theories of motor control. The role of different descending systems in the referent control of posture and movement in the gravitational field is considered.

The rat corticospinal system is functionally and anatomically segregated

The descending corticospinal (CS) projection has been considered a key element for motor control, which results from direct and indirect modulation of spinal cord pre-motor interneurons in the intermediate gray matter of the spinal cord, which, in turn, influences motoneurons in the ventral horn. The CS tract (CST) is also involved in a selective and complex modulation of sensory information in the dorsal horn. However, little is known about the spinal network engaged by the CST and the organization of CS projections that may encode different cortical outputs to the spinal cord. This study addresses the issue of whether the CS system exerts parallel control on different spinal networks, which together participate in sensorimotor integration. Here, we show that in the adult rat, two different and partially intermingled CS neurons in the sensorimotor cortex activate, with different time latencies, distinct spinal cord neurons located in the dorsal horn and intermediate zone of the same segment. The fact that different populations of CS neurons project in a segregated manner suggests that CST is composed of subsystems controlling different spinal cord circuits that modulate motor outputs and sensory inputs in a coordinated manner.

Combined chondroitinase and KLF7 expression reduce net retraction of sensory and CST axons from sites of spinal injury

Axon regeneration in the central nervous system is limited both by inhibitory extracellular cues and by an intrinsically low capacity for axon growth in some CNS populations. Chondroitin sulfate proteoglycans (CSPGs) are well-studied inhibitors of axon growth in the CNS, and degradation of CSPGs by chondroitinase has been shown to improve the extension of injured axons. Alternatively, axon growth can be improved by targeting the neuron-intrinsic growth capacity through forced expression of regeneration-associated transcription factors. For example, a transcriptionally active chimera of Krüppel-like Factor 7 (KLF7) and a VP16 domain improves axon growth when expressed in corticospinal tract neurons. Here we tested the hypothesis that combined expression of chondroitinase and VP16-KLF7 would lead to further improvements in axon growth after spinal injury. Chondroitinase was expressed by viral transduction of cells in the spinal cord, while VP16-KLF7 was virally expressed in sensory neurons of the dorsal root ganglia or corticospinal tract (CST) neurons. After transection of the dorsal columns, both chondroitinase and VP16-KLF7 increased the proximity of severed sensory axons to the injury site. Similarly, after complete crush injuries, VP16-KLF7 expression increased the approach of CST axons to the injury site. In neither paradigm however, did single or combined treatment with chondroitinase or VP16-KLF7 enable regenerative growth distal to the injury. These results substantiate a role for CSPG inhibition and low KLF7 activity in determining the net retraction of axons from sites of spinal injury, while suggesting that additional factors act to limit a full regenerative response.

Corticospinal circuit plasticity in motor rehabilitation from spinal cord injury

Restoring corticospinal function after spinal cord injury is a significant challenge as the corticospinal tract elicits no substantive, spontaneous regeneration, and its interruption leaves a permanent deficit. The corticospinal circuit serves multiple motor and sensory functions within the mammalian nervous system as the direct link between isocortex and spinal cord. Maturation of the corticospinal circuit involves the refinement of projections within the spinal cord and a subsequent refinement of motor maps within the cortex. The plasticity of these cortical motor maps mirrors the acquisition of skilled motor learning, and both the maps and motor skills are disrupted following injury to the corticospinal tract. The motor cortex exhibits the capacity to incorporate changes in corticospinal projections induced by both spontaneous and therapeutic-mediated plasticity of corticospinal axons through appropriate rehabilitation. An understanding of the mechanisms of corticospinal plasticity in motor learning will undoubtedly help inform strategies to improve motor rehabilitation after spinal cord injury.

Reproducibility of transcranial magnetic stimulation metrics in the study of proximal upper limb muscles

OBJECTIVE

Reproducibility of transcranial magnetic stimulation (TMS) metrics is essential in accurately tracking recovery and disease. However, majority of evidence pertains to reproducibility of metrics for distal upper limb muscles. We investigate for the first time, reliability of corticospinal physiology for a large proximal muscle - the biceps brachii and relate how varying statistical analyses can influence interpretations.

METHODS

14 young right-handed healthy participants completed two sessions assessing resting motor threshold (RMT), motor evoked potentials (MEPs), motor map and intra-cortical inhibition (ICI) from the left biceps brachii. Analyses included paired t-tests, Pearson's, intra-class (ICC) and concordance correlation coefficients (CCC) and Bland-Altman plots.

RESULTS

Unlike paired t-tests, ICC, CCC and Pearson's were >0.6 indicating good reliability for RMTs, MEP intensities and locations of map; however values were <0.3 for MEP responses and ICI.

CONCLUSIONS

Corticospinal physiology, defining excitability and output in terms of intensity of the TMS device, and spatial loci are the most reliable metrics for the biceps. MEPs and variables based on MEPs are less reliable since biceps receives fewer cortico-motor-neuronal projections. Statistical tests of agreement and associations are more powerful reliability indices than inferential tests.

SIGNIFICANCE

Reliable metrics of proximal muscles when translated to a larger number of participants would serve to sensitively track and prognosticate function in neurological disorders such as stroke where proximal recovery precedes distal.

Acute changes in soleus H-reflex facilitation and central motor conduction after targeted physical exercises

We tested the acute effect of exercises targeted simultaneously at cortical and brainstem circuits on neural transmission through corticobulbar connections. Corticobulbar pathways represent a potential target for rehabilitation after spinal cord injury (SCI), which tends to spare brainstem circuits to a greater degree than cortical circuits. To explore this concept, able-bodied volunteers (n=20) underwent one session each of three exercises targeted at different nervous system components: treadmill walking (spinal locomotor circuits), isolated balance exercise (brainstem and other pathways), and multimodal balance plus skilled hand exercise (hand motor cortex and corticospinal tract). We found that short-interval soleus H-reflex facilitation increased after one session of balance and multimodal exercise by 13.2±4.0% and 8.3±4.7%, and slightly decreased by 1.9±4.4% after treadmill exercise (p=0.042 on ANOVA across exercise type). Increases in long-interval H-reflex facilitation were not significantly different between exercises. Both balance and multimodal exercise increased central motor conduction velocity by 4.3±2.6% and 4.5±2.8%, whereas velocity decreased by 4.3±2.7% after treadmill exercise (p=0.045 on ANOVA across exercise type). In conclusion, electrophysiological transmission between the motor cortex and spinal motor neurons in able-bodied subjects increased more following one session of balance exercise than treadmill exercise.

Plasticity of subcortical pathways promote recovery of skilled hand function in rats after corticospinal and rubrospinal tract injuries

The corticospinal and rubrospinal tracts are the predominant tracts for controlling skilled hand function. Injuries to these tracts impair grasping but not gross motor functions such as overground locomotion. The aim of the present study was to determine whether or not, after damage to both the corticospinal and rubrospinal tracts, other spared subcortical motor pathway can mediate the recovery of skilled hand function. Adult rats received a bilateral injury to the corticospinal tract at the level of the medullar pyramids and a bilateral ablation of the rubrospinal axons at C4. One group of rats received, acutely after injury, two injections of chondroitinase-ABC at C7, and starting at 7days post-injury were enrolled in daily reaching and grasping rehabilitation (CHASE group, n=5). A second group of rats received analogous injections of ubiquitous penicillinase, and did not undergo rehabilitation (PEN group, n=5). Compared to rats in the PEN group, CHASE rats gradually recovered the ability to reach and grasp over 42days after injury. Overground locomotion was mildly affected after injury and both groups followed similar recovery. Since the reticulospinal tract plays a predominant role in motor control, we further investigated whether or not plasticity of this pathway could contribute to the animal's recovery. Reticulospinal axons were anterogradely traced in both groups of rats. The density of reticulospinal processes in both the normal and ectopic areas of the grey ventral matter of the caudal segments of the cervical spinal cord was greater in the CHASE than PEN group. The results indicate that after damage to spinal tracts that normally mediate the control of reaching and grasping in rats other complementary spinal tracts can acquire the role of those damaged tracts and promote task-specific recovery.