Upper leg conduction time distinguishes demyelinating neuropathies.

BACKGROUND: The objective of this study was to determine whether differentiation between demyelinating and axonal neuropathies could be enhanced by comparing conduction time changes in defined segments of the total peripheral nerve pathway. METHODS: Compound muscle action potentials (CMAPs) were elicited by cathodal stimulation of the tibial nerve at the ankle and popliteal fossa, and by paravertebral neuromagnetic stimulation at proximal and distal cauda equina while recording from muscles of the foot, shin, and thigh. Segmental conduction times were calculated in normal subjects; in patients with lumbosacral radiculopathy, distal symmetric diabetic neuropathy, amyotrophic lateral sclerosis, acute and chronic inflammatory demyelinating polyneuropathy; and in patients with anti-myelin-associated glycoprotein, myelomatous, and Charcot-Marie-Tooth type 1a polyneuropathies. RESULTS: Distal cauda equina latency and CMAP duration and segmental conduction times in upper leg and cauda equina facilitated differentiation of demyelinating from axonal neuropathies, even in the presence of a range of reduced amplitude CMAPs. CONCLUSIONS: Within the demyelinating neuropathy spectrum, it was further possible to distinguish subtypes.

Focal electrically administered therapy: device parameter effects on stimulus perception in humans.

BACKGROUND: Focal electrically administered therapy is a new method of transcranial electrical stimulation capable of focal modulation of cerebral activity. Other than invasive studies in animals and examination of motor output in humans, there are limited possibilities for establishing basic principles about how variation in stimulus parameters impact on patterns of intracortical stimulation. This study used a simpler paradigm and evaluated the effects of different stimulation parameters on subjective perception of the quality and location of scalp pain. METHODS: In 2 studies, 19 subjects were randomly stimulated over the left forehead, varying the anode-cathode arrangement, the intensity of stimulation, the electrode size and placement, and whether the current flow was unidirectional or bidirectional. Subjects rated the location of the sensation and its quality. RESULTS: The perceived center of stimulation moved toward the cathode, regardless of placement. This shift in subjective sensation was more prominent when the electricity was unidirectional. In addition, more intense stimulation, as well as stimulation with a smaller electrode, caused greater perceived pain. Unidirectional stimulation was rated more painful when traveling from a large anode to a small cathode and less painful when traveling from a small anode to a large cathode. Finally, participants were more likely to perceive the electrical stimulation as moving toward a specific direction when the intensity was high than when it was low. CONCLUSIONS: The intensity and location of sensations can be manipulated by varying the intensity, current direction, or geometry of electrodes.

Lateralized neocortical control of T lymphocyte export from the thymus I. Increased export after left cortical stimulation in behaviorally active rats, mediated by sympathetic pathways in the upper spinal cord.

Electrical stimulation of left temporo-parieto-occipital (TPO) cortex in adult male Wistar rats during their behaviorally active phase (nighttime) transiently increased circulating levels of CD4+ and CD8+ T lymphocytes. Comparable stimulation of this cortex on the right decreased circulating levels of these cells. Responses to left or right cortical stimulation were diminished or absent in behaviorally inactive rats (daytime). Since blood glucocorticoid levels were similar before and after left or right stimulation, they did not appear to account for the lateralized changes observed. These lateralized effects were mediated by spinal cord autonomic pathways emerging at Tl-T7 levels. In adult thymectomized rats, CD4+ and CD8+ T cells failed to increase after left sided stimulation. The results suggest that lateralized cerebral cortical functions can acutely and differentially influence blood T cell subset numbers. The results demonstrate a direct neocortical influence on thymic export of mature T cells, mediated by the sympathetic nervous system.

The refractory period of fast conducting corticospinal tract axons in man and its implications for intraoperative monitoring of motor evoked potentials.

OBJECTIVE: To determine the absolute and relative refractory period (RRP) of fast conducting axons of the corticospinal tract in response to paired high intensity (HI or supramaximal) and moderate intensity (MI or submaximal) electrical stimuli. The importance of the refractory period of fast conducting corticospinal tract axons has to be considered if repetitive transcranial electrical stimulation (TES) is to be effective for eliciting motor evoked potentials (MEPs) intraoperatively. METHODS: Direct (D) waves were recorded from the epidural space of the spinal cord in 14 patients, undergoing surgical correction of spinal deformities. To assess the absolute and RRPs of the corticospinal tract, paired transcranial electrical stimuli at interstimulus intervals (ISI) from 0.7 to 4.1 ms were applied. Recovery of conditioned D wave at short (2 ms) and long (4 ms) ISI was correlated with muscle MEP threshold. The refractory period for peripheral nerve was tested in comparison to that for the corticospinal tract. In four healthy subjects sensory nerve action potentials of the median nerve were studied after stimulation with paired stimuli. RESULTS: HI TES revealed a mean duration of 0.82 ms for the absolute refractory period of the corticospinal tract, while MI stimulation resulted in a mean refractory period duration of 1.47 ms. Stimuli of HI produced faster recovery of D wave amplitude during the RRP. Furthermore, short trains of transcranial electrical stimuli did not elicit MEPs when D wave showed incomplete recovery. A similar influence of stimulus intensity on recovery time was found for the refractory period of peripheral nerve. CONCLUSIONS: The recovery of D wave amplitude is dependent upon stimulus intensity. High intensity produces fast recovery. This is an important factor for the generation of MEPs. When HI TES is used to elicit MEPs, short and long ISIs are equally effective. When MI TES is used to elicit MEPs, only a long ISI of 4 ms is effective.

Motor cortical and other cortical interneuronal networks that generate very high frequency waves.

A remarkable feature of motor cortical organization in higher mammals is that a brief electrical stimulus elicits in the pyramidal tract and corticospinal tract an unrelayed direct (D) wave followed by multiple indirect (I) waves at frequencies as high as 500-700 Hz. This review presents some conclusions regarding very high frequency synchronous activity in mammalian cortex: (1) Synchrony in repetitive I discharges is extraordinary in humans and monkeys, less in cats and still less in rats, being there represented by a delayed broad wave; such phylogenetic trends have important implications for the suitability of lower mammalian species for studies of high frequency cortical networks in the human brain; (2) The evidence from microstimulation at different cortical depths and pial cooling favors a vertically oriented chain of interneurons that centripetally excite corticospinal neurons as the basis for inter-I wave periodicity and synchrony; (3) Significantly, the I wave periodicity is conserved despite wide changes in stimulus parameters; (4) Synchronous high frequency activity similar to that of I waves can be recorded from other neocortical areas such as visual and somatosensory cortex; however, evidence is still lacking that the output neurons of these cortical regions have synchronized discharges comparable to I waves; (5) In limbic cortices, the frequency of synchronous neural activity is lower than that in motor cortex or related cortices and periodicity is not conserved with changes in stimulus parameters, indicating a lack of the neocortical interneuronal substrate in limbic cortex; (6) We propose that the very high frequency synchronous activity of motor cortical output reflects a computational function such as a "clock," quantizing times at which inputs would interact preferentially yielding synchronous output discharges. Such circuitry, if a general feature of neocortex, would facilitate rapid communication of significant computations between cortical regions.

Perception of phosphenes and flashed alphabetical characters is enhanced by single-pulse transcranial magnetic stimulation of anterior frontal lobe: the thalamic gate hypothesis.

Single pulses of transcranial magnetic stimulation (sTMS) restricted locally to the primary cortical areas for somatosensory and visual input, unlike the effects of repetitive stimulation, usually fail to elicit projected sensations. We tested the effect of sTMS over anterior frontal cortex in facilitating phosphenes from preceding sTMS over calcarine cortex, which alone was rarely effective in eliciting phosphenes. The combined sTMS elicited complex phosphenes, which changed with the site of frontal sTMS and the interstimulus interval. Our results show that sTMS over anterior frontal cortex also improved reporting of weakly illuminated, flashed four-letter stimuli, which permitted its statistical validation. We propose that the present demonstration of frontal cortical facilitation of visual awareness, when combined with the previous finding of projected paresthesias and sense of movement (Amassian et al, 1991 Brain 114 2505-2520), provide evidence of a general frontal opening effect on a thalamic gate. Opening this gate facilitates entry of information from primary cortical receiving areas to thalamus. Thereby, the reciprocal thalamocortical interrelations that subserve conscious awareness of sensory stimuli could be fostered.

Perisaccadic parietal and occipital gamma power in light and in complete darkness.

Our objective was to determine perisaccadic gamma range oscillations in the EEG during voluntary saccades in humans. We evaluated occipital perisaccadic gamma activity both in the presence and absence of visual input, when the observer was blindfolded. We quantified gamma power in the time periods before, during, and after horizontal saccades. The corresponding EEG was evaluated for individual saccades and the wavelet transformed EEG averaged for each time window, without averaging the EEG first. We found that, in both dark and light, parietal and occipital gamma power increased during the saccade and peaked prior to reaching new fixation. We show that this is not the result of muscle activity and not the result of visual input during saccades. Saccade direction affects the laterality of gamma power over posterior electrodes. Gamma power recorded over the posterior scalp increases during a saccade. The phasic modulation of gamma by saccades in darkness--when occipital activity is decoupled from visual input--provides electrophysiological evidence that voluntary saccades affect ongoing EEG. We suggest that saccade-phasic gamma modulation may contribute to short-term plasticity required to realign the visual space to the intended fixation point of a saccade and provides a mechanism for neuronal assembly formation prior to achieving the intended saccadic goal. The wavelet-transformed perisaccadic EEG could provide an electrophysiological tool applicable in humans for the purpose of fine analysis and potential separation of stages of 'planning' and 'action'.