Assessment of motor pathways by magnetic stimulation in human and veterinary medicine.

Magnetic stimulation is a non-invasive and painless technique for studying the motor pathways in medical neurology. A time-varying magnetic field induces an electrical field in conducting objects, such as nervous tissue. The technique can be applied to nerve roots and peripheral nerves or to the motor cortex of the brain in human and veterinary medicine. In this review, the basic principles, applications and risk factors of peripheral nerve and motor cortex stimulation in human and veterinary medicine are discussed.

Optimization and initial experience of a multisection balanced steady-state free precession cine sequence for the assessment of fetal behavior in utero.

BACKGROUND AND PURPOSE: The assessment of motor function is an essential component of neurologic examinations, which imaging studies have extended to the fetus. US assessment is hampered by a limited FOV, whereas MR imaging has the potential to be an alternative. Our objectives were to optimize a cine MR imaging sequence for capturing fetal movements and to perform a pilot analysis of the relationship between the frequency of movements and uterine spatial constrictions in healthy fetuses. MATERIALS AND METHODS: Initially, a bSSFP cine sequence was selected for optimization, and various compromises were explored in all acquisition parameters to achieve an effective balance between anatomic coverage of the fetus and the temporal resolution of cine data, with the aim of maximizing both. Subsequently, cross-sectional qualitative and quantitative analyses of fetal movements were performed prospectively by using a cohort of 37 healthy fetuses (median GA, 29 weeks; range, 20-37 weeks) with the optimized cine protocol. Two smaller subgroups were selected for representative sampling of overall behavior patterns by using cine data of longer duration and for volumetric quantification of free intrauterine space. RESULTS: The optimized cine sequence, with TR/TE of 3.21/1.59 ms, coupled with parallel imaging and partial-Fourier imaging, resulted in a section-acquisition time of 0.303 seconds. Anatomic coverage was enhanced by using a combination of thick sagittal sections (30-40 mm) and multisection acquisitions to display movements in all fetal limbs, head, and trunk simultaneously. All expected motor patterns were observed throughout this gestational period, and a significant decreasing trend in overall movement frequency with age was demonstrated (r = -0.514, P = .0011). Also a significant negative correlation was found between overall movement frequency and the total intrauterine free space (r = -0.703, P = .0001). Furthermore, a significant decrease in the frequency of leg movements was shown in fetuses older then 30 weeks' GA compared with those younger than that (P = .015). CONCLUSIONS: Cine MR imaging is effective for observing fetal movements from midgestation with near full-body coverage. Also, reductions in free space with increasing GA appear to be a factor in the gradual reductions in overall levels of fetal activity as well as in restrictions in movement within specific regions of the fetal anatomy.

A computer model of auditory efferent suppression: implications for the recognition of speech in noise.

The neural mechanisms underlying the ability of human listeners to recognize speech in the presence of background noise are still imperfectly understood. However, there is mounting evidence that the medial olivocochlear system plays an important role, via efferents that exert a suppressive effect on the response of the basilar membrane. The current paper presents a computer modeling study that investigates the possible role of this activity on speech intelligibility in noise. A model of auditory efferent processing [Ferry, R. T., and Meddis, R. (2007). J. Acoust. Soc. Am. 122, 3519-3526] is used to provide acoustic features for a statistical automatic speech recognition system, thus allowing the effects of efferent activity on speech intelligibility to be quantified. Performance of the "basic" model (without efferent activity) on a connected digit recognition task is good when the speech is uncorrupted by noise but falls when noise is present. However, recognition performance is much improved when efferent activity is applied. Furthermore, optimal performance is obtained when the amount of efferent activity is proportional to the noise level. The results obtained are consistent with the suggestion that efferent suppression causes a "release from adaptation" in the auditory-nerve response to noisy speech, which enhances its intelligibility.

Simultaneous assessment of the effects of L-type current modulators on sensory and motor pathways of the mouse spinal cord in vitro.

The effects of modulators of L-type currents in the processing of nociceptive stimuli across sensory and motor circuits were studied using an in vitro preparation of the young mouse spinal cord. Responses to repetitive C-fibre intensity stimuli delivered to a lumbar dorsal root were simultaneously recorded from motor axons in the corresponding ventral root and from putative sensory axons in the anterolateral pathway. L-current antagonists verapamil, diltiazem and nimodipine as well as the agonist Bay K8644 were superfused at a range of concentrations and their effects on responses to afferent stimulation were assessed. All antagonists produced a concentration-dependent depression of transmission across sensory and motor pathways by inhibiting sustained firing and wind-up. All antagonists showed concentration-dependent depression of evoked firing in anterolateral fibres with LogIC50 of -4.2 for verapamil, -4.1 for diltiazem and -4.9 for nimodipine. Applied at high concentrations (>or=100 microM) verapamil and diltiazem produced almost complete blockade of the ascending signals whereas nimodipine produced only partial depression. The effects of the antagonists on motor pathways were significantly greater and the LogIC50 decreased to -5 for verapamil, to -4.9 for diltiazem and to -5.3 for nimodipine. Bay K8644 applied at 2 microM produced only a slight potentiation of responses in anterolateral axons and a very large and long-lasting potentiation of responses from motor neurons. We conclude that mice motor pathways are more sensitive to L-type current modulators than the anterolateral pathway and that analgesic effects reported for some L-type antagonists may be due to a mixture of selective and non-selective effects of these agents on sensory neurones.

A high-precision, low cost system for evaluating finger-tapping tasks.

Finger-tapping test is extensively employed to assess motor asymmetry in brain damaged patients and also to study the relationship between handedness and performance in normal subjects. The aim of this study was to develop a computer based finger-tapping system that could provide quantitative measures of finger-tapping performance. The system is designed to be used in a standard personnel computer without the need of any other hardware. The software is written in Borland Delphi 6.0 for Microsoft Windows 98 and higher operating systems. Beginning with the Pentium processor, it could be possible to access a time-stamp counter. The time-stamp counter is a 64-bit machine specific register that is incremented by every clock cycle, and keeps an accurate count of every cycle that occurs on the processor. By using a computer with 1 GHz processor speed it is possible to reach a high precision time resolution of 1 mus in finger-tapping tests. Our future prospects for the system are to improve it with various tools such as synchronized recording of electromyography, tapping force monitoring, monitoring of finger angle, and the response to different stimulus parameters by adding appropriate hardware and procedure.

Estimating resting motor thresholds in transcranial magnetic stimulation research and practice: a computer simulation evaluation of best methods.

OBJECTIVES: Resting motor threshold is the basic unit of dosing in transcranial magnetic stimulation (TMS) research and practice. There is little consensus on how best to estimate resting motor threshold with TMS, and only a few tools and resources are readily available to TMS researchers. The current study investigates the accuracy and efficiency of 5 different approaches to motor threshold assessment for TMS research and practice applications. METHODS: Computer simulation models are used to test the efficiency and accuracy of 5 different adaptive parameter estimation by sequential testing (PEST) procedures. For each approach, data are presented with respect to the mean number of TMS trials necessary to reach the motor threshold estimate as well as the mean accuracy of the estimates. RESULTS: A simple nonparametric PEST procedure appears to provide the most accurate motor threshold estimates, but takes slightly longer (on average, 3.48 trials) to complete than a popular parametric alternative (maximum likelihood PEST). Recommendations are made for the best starting values for each of the approaches to maximize both efficiency and accuracy. CONCLUSIONS: In light of the computer simulation data provided in this article, the authors review and suggest which techniques might best fit different TMS research and clinical situations. Lastly, a free user-friendly software package is described and made available on the world wide web that allows users to run all of the motor threshold estimation procedures discussed in this article for clinical and research applications.

Neuronal pathway from the liver modulates energy expenditure and systemic insulin sensitivity.

Coordinated control of energy metabolism and glucose homeostasis requires communication between organs and tissues. We identified a neuronal pathway that participates in the cross talk between the liver and adipose tissue. By studying a mouse model, we showed that adenovirus-mediated expression of peroxisome proliferator-activated receptor (PPAR)-g2 in the liver induces acute hepatic steatosis while markedly decreasing peripheral adiposity. These changes were accompanied by increased energy expenditure and improved systemic insulin sensitivity. Hepatic vagotomy and selective afferent blockage of the hepatic vagus revealed that the effects on peripheral tissues involve the afferent vagal nerve. Furthermore, an antidiabetic thiazolidinedione, a PPARg agonist, enhanced this pathway. This neuronal pathway from the liver may function to protect against metabolic perturbation induced by excessive energy storage.

Assessment of medial olivocochlear system function in pre-term and full-term newborns using a rapid test of transient otoacoustic emissions.

This study was conducted to investigate maturation of the medial olivocochlear efferent system (MOCS) in pre- and full-term neonates using Quickscreen (Otodynamics Ltd) and to confirm previous findings on transient otoacoustic emission (TEOAE) suppression in neonates. MOCS maturation was investigated in 46 neonates born at the Chaim Sheba Medical Center, Tel Hashomer, Israel, using Quickscreen. All neonates were normal with no family history of general or auditory disease and no risk factors for hearing impairment. MOCS function appears gradually in human pre-term neonates and is considered to reach maturity shortly after term birth. The clinical value of MOCS testing in specific populations of newborns at risk for hearing and/or brainstem function can be legitimately raised as activation of the MOCS clearly alters cochlear output. The present results can be interpreted to support the testing of infants at risk of developing abnormal MOCS function using a commercially available rapid TEOAE measurement system.

Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients.

OBJECT: Intraoperative stimulation mapping of subcortical white matter tracts during the resection of gliomas has become a valuable surgical adjunct that is used to reduce morbidity associated with tumor removal. The purpose of this retrospective analysis was to assess the morbidity and functional outcome associated with this method, thus allowing the surgeon to predict the likelihood of causing a temporary or permanent motor deficit. METHODS: In this study, the authors report their experience with intraoperative stimulation mapping to locate subcortical motor pathways in 294 patients who underwent surgery for hemispheric gliomas within or adjacent to the rolandic cortex. Data were collected regarding intraoperative cortical and subcortical stimulation mapping results, along with the patient's neurological status pre- and postoperatively. For patients in whom an additional motor deficit occurred postoperatively, its evolution was examined. Of 294 patients, an additional postoperative motor deficit occurred in 60 (20.4%). Of those 60, 23 (38%) recovered to their preoperative baseline status within the 1st postoperative week. Another 12 (20%) recovered from their postoperative motor deficit by the end of the 4th postoperative week, and 11 more recovered to their baseline status by the end of the 3rd postoperative month. Thus, 46 (76.7%) of 60 patients with postoperative motor deficits regained their baseline function within the first 90 days after surgery. The remaining 14 patients (4.8% of the entire study population of 294) had a persistent motor deficit after 3 months. Patients whose subcortical pathways were identified with stimulation mapping were more prone to develop an additional (temporary or permanent) motor deficit than those in whom subcortical pathways could not be identified (27.5% compared with 13.1%, p = 0.003). This was also true when additional (permanent) motor deficits lasted more than 3 months (7.4% when subcortical pathways were found, compared with 2.1% when they were not found; p = 0.041). CONCLUSIONS: In patients with gliomas that are located within or adjacent to the rolandic cortex and, thus, the descending motor tracts, stimulation mapping of subcortical pathways enables the surgeon to identify these descending motor pathways during tumor removal and to achieve an acceptable rate of permanent morbidity in these high-risk functional areas.

A new, concise dialysis approach to assessment of cardiac sympathetic nerve terminal abnormalities.

We applied a dialysis technique to the hearts of anesthetized cats and examined whether the concentration of dialysate norepinephrine (NE) reflected NE disposition at the cardiac sympathetic nerve terminals. Dialysis probes were implanted in the left ventricular wall, and dialysate NE concentrations were measured as an index of myocardial interstitial NE levels. Stimulation of stellate ganglia significantly increased dialysate NE responses that were suppressed by local administration of an NE-releasing inhibitor (omega-conotoxin GVIA, 10 microM). Increments in basal dialysate NE levels were correlated with concentrations of a locally administered neuronal uptake blocker (desipramine; 1, 10, and 100 microM). Desipramine (100 microM) augmented stimulation-induced dialysate NE responses. Local administration of a neuronal vesicle uptake blocker (reserpine, 1 and 10 microM) did not alter dialysate NE levels but increased dialysate dihydroxyphenylglycol levels. An NE-releasing amine (tyramine, 100 microg/ml) was locally administered to examine NE storage capacity at the nerve terminal. The tyramine-induced NE-releasing response was completely abolished by pretreatment with reserpine (1 mg/kg i.p.). Thus cardiac dialysis with local administration of a pharmacological tool offers a new, concise approach to assessment of neuronal NE release, uptake, vesicle uptake, and storage capacity by cardiac sympathetic nerve terminals.

Quantitative assessment of the effect of basal ganglia lesions on the stretch reflex in primates.

The effect of basal ganglia stereotactic lesions on motor tone in 3 primates was quantitated. The elastic and neurogenic forces generated with a controlled stretch of each animal's upper extremities were measured pre- and postlesion, and compared to previous studies. The techniques were sensitive to subtle changes in motor tone that were not clinically apparent. The results suggest that the basal ganglia, through the outflow path of the globus pallidus, is important in controlling the sensitivity of both flexors and extensors to stretch. These quantification techniques also have promise in evaluating treatment regimens for spasticity, rigidity, and other conditions with abnormal motor tone.

Rapid assessment of sound-evoked olivocochlear feedback: suppression of compound action potentials by contralateral sound.

The compound action potential (CAP) measured at the round window of anesthetized cats in response to low-level tone pips can be significantly suppressed by addition of tones or noise to the opposite ear. This contralateral-sound suppression disappears upon transection of the olivocochlear bundle. The frequency and level dependence of the suppression phenomenon are well explained by known sound-evoked discharge properties of single olivocochlear neurons. Thus, the contralateral-sound suppression of cochlear CAP should prove useful as a rapid measure of the magnitude of the sound-evoked efferent feedback to the cochlea.

Retrograde transport of nerve growth factor (NGF) in motoneurons of developing rats: assessment of potential neurotrophic effects.

The potential functional significance of nerve growth factor (NGF) receptors in spinal motoneurons was studied in newborn rats. 125I-NGF was specifically retrogradely transported by motoneurons from their peripheral nerve terminals. This transport was blocked by an excess of unlabeled NGF but not by cytochrome c. 125I-cytochrome c was not transported. The monoclonal anti-rat NGF receptor antibody, but not a control antibody, was also transported. Despite this ability of motoneurons to transport NGF, treatment of newborn rats with this factor did not increase motoneuron size or synthesis of neurotransmitter enzymes and did not prevent cell death after axotomy. We conclude that NGF receptors of spinal motoneurons can bind, internalize, and retrogradely transport NGF. However, these receptors do not mediate the classic trophic effects of NGF.

Neuroanatomy, neurophysiology, and central auditory assessment. Part III: Corpus callosum and efferent pathways.

In this, the last of a three-part series on neuroanatomy/physiology related to central auditory assessment, two topics will be presented: the corpus callosum and the efferent auditory system. A general anatomical description of the corpus callosum is followed by information on the topographical representation of the cortex within the corpus callosum. Auditory areas of the corpus callosum and the transcallosal auditory pathway are emphasized. Data on transfer time across the corpus callosum and the possible role of inhibitory and excitatory fibers of this commissure are presented. Neuropsychological studies relative to neuroanatomy/physiology of the corpus callosum are discussed, and the efferent auditory system from cortex to cochlea is described. Emphasis is placed on the structure and function of the olivocochlear bundle along with some clinical relationships to probable disorders of the descending pathway of the caudal brain stem.

Reflex actions of muscle afferents on fusimotor innervation in decerebrated cats: an assessment of beta contributions.

The existence of beta innervation in many cat muscles raises the possibility that spindle afferent discharge will excite beta motoneurons, augmenting spindle afferent discharge and thereby closing a positive feedback loop. In order to evaluate the strength of such a loop through beta motoneurons and muscle spindles, the stretch responses of muscle spindle afferents from medial gastrocnemius (MG) and soleus (SOL) muscles were studied in decerebrated cats before and after dorsal root section. If a positive feedback loop were operational, the spindle afferent stretch response should be diminished following dorsal root section by an amount related to the magnitude of positive feedback. After dorsal root section, the static positional sensitivities of our MG spindle afferent sample were significantly reduced for 72% (13/18, p less than 0.05) of the afferents, and dynamic rate/length slopes were decreased for 88% (8/9) of a subset of the afferents studied. Similar reductions for 6 afferents from SOL were not found. To apportion these afferent changes to reflex excitation of either gamma or beta motoneurons, we recorded the stretch responses of gamma and alpha-type fibers in the same preparation. (We assume that the population of alpha-type fibers includes beta fibers). In keeping with other reports, alpha fibers were much more responsive to stretch than gamma fibers. The mean positional sensitivity for alpha fibers (1.29 +/- 0.92 pps/mm, n = 15) was greater (p less than 0.05) than that of gamma fibers (0.49 +/- 0.93 pps/mm, n = 18). Because of these differences in sensitivity, beta motoneurons are more likely (than gamma motoneurons) to be involved in a positive feedback loop, although some gamma contribution is also likely. Using equations based on a beta position regulating scheme, differences in spindle positional sensitivity were used to estimate beta loop gain. The average loop gain was estimated to be 0.41 (n = 18). The contribution of such a beta configuration to reducing the sensitivity of muscle to changes in load and muscle properties is evaluated.