Spatio-temporal mapping cortical neuroplasticity in carpal tunnel syndrome.

Neuroimaging data demonstrate that carpal tunnel syndrome, a peripheral neuropathy, is accompanied by maladaptive central neuroplasticity. To further investigate this phenomenon, we collected magnetoencephalography data from 12 patients with carpal tunnel syndrome and 12 healthy control subjects undergoing somatosensory stimulation of the median nerve-innervated Digits 2 and 3, as well as Digit 5, which is innervated by the ulnar nerve. Nerve conduction velocity and psychophysical data were acquired to determine whether standard clinical measures correlated with brain response. In subjects with carpal tunnel syndrome, but not healthy controls, sensory nerve conduction velocity for Digits 2 and 3 was slower than Digit 5. However, somatosensory M20 latencies for Digits 2 and 3 were significantly longer than those of Digit 5. The extent of the M20 delay for median nerve-innervated Digit 2 was positively correlated with decreasing nerve conduction velocity and increasing pain severity. Thus, slower peripheral nerve conduction in carpal tunnel syndrome corresponds to greater delays in the first somatosensory cortical response. Furthermore, spectral analysis demonstrated weaker post-stimulus beta event-related desynchronization and earlier and shorter event-related synchronization in subjects with carpal tunnel syndrome. The extent of the decreased event-related desynchronization for median nerve-innervated digits was positively correlated with paraesthesia severity. We propose that ongoing paraesthesias in median nerve-innervated digits render their corresponding sensorimotor cortical areas 'busy', thus reducing their capacity to process external stimulation. Finally, subjects with carpal tunnel syndrome demonstrated a smaller cortical source separation for Digits 2 and 3 compared with healthy controls. This supports our hypothesis that ongoing paraesthesias promote blurring of median nerve-innervated digit representations through Hebbian plasticity mechanisms. In summary, this study reveals significant correlation between the clinical severity of carpal tunnel syndrome and the latency of the early M20, as well as the strength of long latency beta oscillations. These temporal magnetoencephalography measures are novel markers of neuroplasticity in carpal tunnel syndrome and could be used to study central changes that may occur following clinical intervention.

Differences in cortical response to acupressure and electroacupuncture stimuli.

BACKGROUND: FMRI studies focus on sub-cortical effects of acupuncture stimuli. The purpose of this study was to assess changes in primary somatosensory (S1) activity over the course of different types of acupuncture stimulation. We used whole head magnetoencephalography (MEG) to map S1 brain response during 15 minutes of electroacupuncture (EA) and acupressure (AP). We further assessed how brain response changed during the course of stimulation. RESULTS: Evoked brain response to EA differed from AP in its temporal dynamics by showing clear contralateral M20/M30 peaks while the latter demonstrated temporal dispersion. Both EA and AP demonstrated significantly decreased response amplitudes following five minutes of stimulation. However, the latency of these decreases were earlier in EA (~30 ms post-stimulus) than AP (> 100 ms). Time-frequency responses demonstrated early onset, event related synchronization (ERS), within the gamma band at ~70-130 ms and the theta band at ~50-200 ms post-stimulus. A prolonged event related desynchronization (ERD) of alpha and beta power occurred at ~100-300 ms post-stimulus. There was decreased beta ERD at ~100-300 ms over the course of EA, but not AP. CONCLUSION: Both EA and AP demonstrated conditioning of SI response. In conjunction with their subcortical effects on endogenous pain regulation, these therapies show potential for affecting S1 processing and possibly altering maladaptive neuroplasticity. Thus, further investigation in neuropathic populations is needed.

Brain encoding of acupuncture sensation--coupling on-line rating with fMRI.

Acupuncture-induced sensations have historically been associated with clinical efficacy. These sensations are atypical, arising from sub-dermal receptors, and their neural encoding is not well known. In this fMRI study, subjects were stimulated at acupoint PC-6, while rating sensation with a custom-built, MR-compatible potentiometer. Separate runs included real (ACUP) and sham (SHAM) acupuncture, the latter characterized by non-insertive, cutaneous stimulation. FMRI data analysis was guided by the on-line rating timeseries, thereby localizing brain correlates of acupuncture sensation. Sensation ratings correlated with stimulation more (p<0.001) for SHAM (r=0.63) than for ACUP (r=0.32). ACUP induced stronger and more varied sensations with significant persistence into no-stimulation blocks, leading to more run-time spent rating low and moderate sensations compared to SHAM. ACUP sensation correlated with activation in regions associated with sensorimotor (SII, insula) and cognitive (dorsomedial prefrontal cortex (dmPFC)) processing, and deactivation in default-mode network (DMN) regions (posterior cingulate, precuneus). Compared to SHAM, ACUP yielded greater activity in both anterior and posterior dmPFC and dlPFC. In contrast, SHAM produced greater activation in sensorimotor (SI, SII, insula) and greater deactivation in DMN regions. Thus, brain encoding of ACUP sensation (more persistent and varied, leading to increased cognitive load) demonstrated greater activity in both cognitive/evaluative (posterior dmPFC) and emotional/interoceptive (anterior dmPFC) cortical regions. Increased cognitive load and dmPFC activity may be a salient component of acupuncture analgesia--sensations focus attention and accentuate bodily awareness, contributing to enhanced top-down modulation of any nociceptive afference and central pain networks. Hence, acupuncture may function as a somatosensory-guided mind-body therapy.

Spatiotemporal dynamics of modality-specific and supramodal word processing.

The ability of written and spoken words to access the same semantic meaning provides a test case for the multimodal convergence of information from sensory to associative areas. Using anatomically constrained magnetoencephalography (aMEG), the present study investigated the stages of word comprehension in real time in the auditory and visual modalities, as subjects participated in a semantic judgment task. Activity spread from the primary sensory areas along the respective ventral processing streams and converged in anterior temporal and inferior prefrontal regions, primarily on the left at around 400 ms. Comparison of response patterns during repetition priming between the two modalities suggest that they are initiated by modality-specific memory systems, but that they are eventually elaborated mainly in supramodal areas.

Neuroimaging acupuncture effects in the human brain.

Acupuncture is an ancient East Asian healing modality that has been in use for more than 2000 years. Unfortunately, its mechanisms of action are not well understood, and controversy regarding its clinical efficacy remains. Importantly, acupuncture needling often evokes complex somatosensory sensations and may modulate the cognitive/affective perception of pain, suggesting that many effects are supported by the brain and extending central nervous system (CNS) networks. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, electroencephalography, and magnetoencephalography provide a means to safely monitor brain activity in humans and may be used to help map the neurophysiological correlates of acupuncture. In this review, we will summarize data from acupuncture neuroimaging research and discuss how these findings contribute to current hypotheses of acupuncture action.

Understanding Immersivity: Image Generation and Transformation Processes in 3D Immersive Environments.

Most research on three-dimensional (3D) visual-spatial processing has been conducted using traditional non-immersive 2D displays. Here we investigated how individuals generate and transform mental images within 3D immersive (3DI) virtual environments, in which the viewers perceive themselves as being surrounded by a 3D world. In Experiment 1, we compared participants' performance on the Shepard and Metzler (1971) mental rotation (MR) task across the following three types of visual presentation environments; traditional 2D non-immersive (2DNI), 3D non-immersive (3DNI - anaglyphic glasses), and 3DI (head mounted display with position and head orientation tracking). In Experiment 2, we examined how the use of different backgrounds affected MR processes within the 3DI environment. In Experiment 3, we compared electroencephalogram data recorded while participants were mentally rotating visual-spatial images presented in 3DI vs. 2DNI environments. Overall, the findings of the three experiments suggest that visual-spatial processing is different in immersive and non-immersive environments, and that immersive environments may require different image encoding and transformation strategies than the two other non-immersive environments. Specifically, in a non-immersive environment, participants may utilize a scene-based frame of reference and allocentric encoding whereas immersive environments may encourage the use of a viewer-centered frame of reference and egocentric encoding. These findings also suggest that MR performed in laboratory conditions using a traditional 2D computer screen may not reflect spatial processing as it would occur in the real world.

Acupuncture modulates resting state connectivity in default and sensorimotor brain networks.

Previous studies have defined low-frequency, spatially consistent networks in resting fMRI data which may reflect functional connectivity. We sought to explore how a complex somatosensory stimulation, acupuncture, influences intrinsic connectivity in two of these networks: the default mode network (DMN) and sensorimotor network (SMN). We analyzed resting fMRI data taken before and after verum and sham acupuncture. Electrocardiography data were used to infer autonomic modulation through measures of heart rate variability (HRV). Probabilistic independent component analysis was used to separate resting fMRI data into DMN and SMN components. Following verum, but not sham, acupuncture there was increased DMN connectivity with pain (anterior cingulate cortex (ACC), periaqueductal gray), affective (amygdala, ACC), and memory (hippocampal formation, middle temporal gyrus) related brain regions. Furthermore, increased DMN connectivity with the hippocampal formation, a region known to support memory and interconnected with autonomic brain regions, was negatively correlated with acupuncture-induced increase in a sympathetic related HRV metric (LFu), and positively correlated with a parasympathetic related metric (HFu). Following verum, but not sham, acupuncture there was also increased SMN connectivity with pain-related brain regions (ACC, cerebellum). We attribute differences between verum and sham acupuncture to more varied and stronger sensations evoked by verum acupuncture. Our results demonstrate for the first time that acupuncture can enhance the post-stimulation spatial extent of resting brain networks to include anti-nociceptive, memory, and affective brain regions. This modulation and sympathovagal response may relate to acupuncture analgesia and other potential therapeutic effects.

Spatiotemporal mapping the neural correlates of acupuncture with MEG.

Acupuncture is an ancient Eastern healing modality with putative therapeutic applications. Unfortunately, little is known about the central mechanisms by which acupuncture may exert its effects. In this study, 16 [corrected] healthy subjects were evaluated with magnetoencephalography (MEG) to map the location and timing of brain activity during low-frequency electroacupuncture (EA) and mechanical, noninsertive, sham acupuncture (SA) given at acupoint PC-6. Both EA and SA evoked brain responses that localized to contralateral primary somatosensory (SI) cortex. However, initial responses for EA peaked slightly earlier than those for SA and were located inferiorly within SI. Average equivalent current dipole strength was stronger (particularly at latencies >60 ms) for SA. These spatiotemporal differences between activations elicited by EA and SA are likely attributable to stimulus modality (electrical versus mechanical) and differences in the underlying somatosensory fibers transmitting these signals. The present data confirm that acupuncture modulates activity within somatosensory cortex, providing support for previous studies that suggest that the therapeutic effects of acupuncture are linked to SI modulation. Thus, MEG provides excellent spatiotemporal characterization of the somatosensory component of acupuncture, and future studies can contrast derived brain response parameters in healthy controls with those found in a diseased state.

Spatiotemporal cortical dynamics underlying abstract and concrete word reading.

The current study used whole-head anatomically constrained magnetoencephalography (aMEG) to spatiotemporally map brain responses while subjects made abstract/concrete judgments on visually presented words. Both word types evoked a similar posterior-to-anterior sequence of cortical recruitment involving occipital, temporal, parietal, and frontal areas from approximately 100 to 900 ms poststimulus. A prominent left temporofrontal N400m was smaller to abstract words, while the right temporal N400m was smaller to concrete words, suggesting that differences may exist in their semantic representation. The left temporofrontal decrease for abstract words is consistent with EEG studies, indicating a smaller N400 for abstract words based on a more extensive or accessible lexicosemantic network. Furthermore, the N400m peaked at approximately 420 ms and was followed by a large right hemisphere medial occipitoparietal as well as lateral parietal response to concrete words peaking at approximately 550 ms, perhaps embodying imagistic processing. These data suggest that words may be initially understood using a left-lateralized (frontotemporal) verbal-linguistic system that for concrete words is supplemented after a short delay by a right parietal and medial occipital imagistic network.

Spatiotemporal brain maps of delayed word repetition and recognition.

Whole-head magnetoencephalography (MEG) was used to spatiotemporally map the brain response underlying episodic retrieval of words studied a single time following a long delay (approximately 40 min). Recognition following a long delay occurs as a strong, sustained, differential response, within bilateral, ventral, and lateral prefrontal cortex, anterior temporal and medial parietal regions from approximately 500 ms onward, as well as ventral occipitotemporal regions from approximately 700 ms onward. In comparison with previous tasks using multiple repetitions at short delays, these effects were centered within the same areas (anteroventral temporal and ventral prefrontal) but were shifted to longer latencies (approximately 500 ms vs. approximately 200 ms), were less left-lateralized, and appear more in anterolateral prefrontal regions and less in lateral temporal cortex. Furthermore, comparison of correctly classified words with misclassified, novel and repeated words, suggests that these frontotemporal-parietocingulate responses are sensitive to actual as well as perceived repetition. The results also suggest that lateral prefrontal regions may participate more in controlled effortful retrieval, while left ventral frontal and anterior temporal responses may support sustained lexicosemantic processing. Additionally, left ventromedial temporal sites may be relatively more involved in episodic retrieval, while lateral temporal sites may participate more in automatic priming.

Spatiotemporal maps of past-tense verb inflection.

Does the brain inflect verbs by applying rules, by associative retrieval of the inflected form, or both? We used whole-head magnetoencephalography to spatiotemporally map the brain response underlying verb past-tense inflection. Placing either regular or irregular verbs into the past tense sequentially modulates the bilateral visual, left inferotemporal, posterior superior temporal (Wernicke's area), left inferior prefrontal (Broca's area), and right prefrontal cortices. Although irregular and regular verb inflection evokes similar cortical response patterns, differences in specific frontotemporal regions are observed. At approximately 340 ms, irregular verbs evoke greater response modulation in left occipitotemporal cortex. This modulation occurs when widespread areas are simultaneously active, suggesting that it reflects associative activation necessary for generation of past-tense forms. Subsequently, regular verbs show increased response at approximately 470 ms within left inferior prefrontal regions associated with rule-based inflection. Increased right dorsolateral prefrontal response at approximately 570 ms may represent directed/effortful retrieval of irregular past-tense forms. Thus, the brain inflects verbs by dynamically modulating different functional divisions of an integrated language system.

N400-like magnetoencephalography responses modulated by semantic context, word frequency, and lexical class in sentences.

Words have been found to elicit a negative potential at the scalp peaking at approximately 400 ms that is strongly modulated by semantic context. The current study used whole-head magnetoencephalography (MEG) as male subjects read sentences ending with semantically congruous or incongruous words. Compared with congruous words, sentence-terminal incongruous words consistently evoked a large magnetic field over the left hemisphere, peaking at approximately 450 ms. Source modeling at this latency with conventional equivalent current dipoles (ECDs) placed the N400 m generator in or near the left superior temporal sulcus. A distributed solution constrained to the cortical surface suggested a sequence of differential activation, beginning in Wernicke's area at approximately 250 ms, spreading to anterior temporal sites at approximately 270 ms, to Broca's area by approximately 300 ms, to dorsolateral prefrontal cortices by approximately 320 ms, and to anterior orbital and frontopolar cortices by approximately 370 ms. Differential activity was exclusively left-sided until >370 ms, and then involved right anterior temporal and orbital cortices. At the peak of the N400 m, activation in the left hemisphere was estimated to be widespread in the anterior temporal, perisylvian, orbital, frontopolar, and dorsolateral prefrontal cortices. In the right hemisphere, the orbital, as well as, weakly, the right anterior temporal cortices were activated. Similar but weaker field patterns were evoked by intermediate words in the sentences, especially to low-frequency words occurring in early sentence positions where there is little preceding context. The locations of the N400 m sources identified with the distributed solution correspond well with those previously demonstrated with direct intracranial recordings, and suggested by functional magnetic resonance imaging (fMRI). These results help identify a distributed cortical network that supports online semantic processing.