The spatiotemporal dynamics of early attention processes: a high-resolution electroencephalographic study of N2 subcomponent sources.

The N2 subcomponents of event-related potentials are known to reflect early attentional processes. The anterior N2 may reflect conflict monitoring, whereas the posterior N2 may be involved in target detection. The aim of this study was to identify the brain areas involved in the generation of the N2 subcomponents, in order to define the spatiotemporal dynamics of these attentional processes. We recorded 128-channel electroencephalograms in 15 healthy controls performing a three-stimulus visual oddball task and identified standard-, distracter- and target-elicited N2 components. Individual N2 sources were localized using standardized-weighted-low-resolution-electromagnetic-tomography (swLORETA). Comparative analyses were performed with a non-parametric permutation technique. Common N2 generators were observed in the Brodmann area (BA) 24 of the anterior cingulate cortex (ACC). The posterior cingulate cortex and the central precuneus were more involved in distracter processing, whereas the anterior precuneus and BA 32 of the ACC were target-specific. In accordance with previous demonstration of the frontoparietal cortex's critical role in attentional processes, these new data shed light on the ACC's role in conflict monitoring and its interaction with other median and frontoparietal structures in early attentional processes.

Stimulus-driven attention modulates the release of anticipatory postural adjustments during step initiation.

OBJECTIVE: Step initiation can be modified by environmental stimulations, suggesting the involvement of stimulus-driven attention. Therefore, we assessed the influence of attentional status during step preparation. METHODS: Fourteen healthy, young subjects were presented with an auditory oddball paradigm in which an infrequent "target" stimulus was presented among frequent "standard" stimuli. An imperative visual "Go" signal for step initiation was presented 1.4s after the auditory stimulus. Both the P300 event-related potential (associated with the auditory attention task) and the trajectory of the centre of pressure (associated with step initiation) were recorded. RESULTS: When presented before the visual "Go" signal, the auditory stimuli prompted the early release of low-amplitude anticipatory postural adjustments, not followed by step execution. They occurred twice as frequently in the "target" condition as they did in the "standard" condition. P300 component was greater after presentation of the target stimulus than after presentation of the standard stimulus. CONCLUSION: Stimulus-driven attention can modify the release of anticipatory postural adjustments. SIGNIFICANCE: The cortical integration of an auditory stimulus (as evidenced by the P300 component) in a subject conditioned to initiate gait appears to release postural adjustments via two different attentional mechanisms: an "alerting effect" and an "orienting effect".

Anticipatory postural adjustments during step initiation: elicitation by auditory stimulation of differing intensities.

Step initiation is associated with anticipatory postural adjustments (APAs) that vary according to the speed of the first step. When step initiation is elicited by a "go" signal (i.e. in a reaction time task), the presentation of an unpredictable, intense, acoustic startling stimulus (engaging a subcortical mechanism) simultaneously with or just before the imperative "go" signal is able to trigger early-phase APAs. The aim of the present study was to better understand the mechanisms underlying APAs during step initiation. We hypothesized that the early release of APAs by low-intensity, non-startling stimuli delivered long before an imperative "go" signal indicates the involvement of several different mechanisms in triggering APAs (and not just acoustic reflexes triggering brainstem structures). Fifteen healthy subjects were asked to respond to an imperative visual "go" signal by initiating a step with their right leg. A brief, binaural 40, 80 or 115 dB auditory stimulus was given 1.4 s before the "go" signal. Participants were instructed not to respond to the auditory stimulus. The centre of pressure trajectory and the electromyographic activity of the orbicularis oculi, sternocleidomastoid and tibialis anterior muscles were recorded. All three intensities of the auditory stimulus were able to evoke low-amplitude, short APAs without subsequent step execution. The louder the stimulus, the more frequent the elicitation. Depending on the intensity of the stimulus, APAs prior to step initiation can be triggered without the evocation of a startle response or an acoustic blink. Greater reaction times for these APAs were observed for non-startling stimuli. This observation suggested the involvement of pathways that did not involve the brainstem as a "prime mover".

Movement preparation and cortical processing of afferent inputs in cortical tremor: an event-related (de)synchronization (ERD/ERS) study.

OBJECTIVE: We sought to characterize cortical activity related to motor control in patients presenting with isolated cortical tremor, in order to determine whether or not myoclonus-related impairments are a source of event-related desynchronization/synchronization (ERD/ERS) disruption. METHODS: Nine patients presenting with isolated cortical tremor were compared with controls. Mu and beta ERD/ERS were computed over the scalp and brain surfaces using 128-channel electroencephalographic (EEG) recording during voluntary and passive finger extensions. We recorded somatosensory-evoked potentials following median nerve stimulation and performed myoclonic jerk-locked back-averaging of EEG activity. RESULTS: Back-averaging revealed a cortical premyoclonic spike in all patients. Five of the nine patients had exaggerated SEPs. The amplitude of mu ERD was greater in patients. Beta ERD/ERS did not differ from that seen in controls. Localizations of mu and beta ERD/ERS did not differ from controls and were identified in pre- and post-central sensorimotor cortical areas. CONCLUSIONS: The present results suggest a hyperexcitability of the cortico-subcortical loops responsible for movement preparation and execution. Post-movement inhibition related to cortical processing of afferent input is unaffected in isolated cortical myoclonus. SIGNIFICANCE: Intracortical abnormalities can differ in patients suffering from cortical myoclonus, according to whether or not the individuals have associated epileptic symptoms.

Cortical involvement in the sensory and motor symptoms of primary restless legs syndrome.

BACKGROUND: Restless legs syndrome (RLS) is characterized by closely interrelated motor and sensory disorders. Two types of involuntary movement can be observed: periodic leg movements during wakefulness (PLMW) and periodic leg movements during sleep (PLMS). Basal ganglia dysfunction in primary RLS has often been suggested. However, clinical observations raise the hypothesis of sensorimotor cortical involvement in RLS symptoms. Here, we explored cortical function via movement-related beta and mu rhythm reactivity. METHODS: Twelve patients with idiopathic, primary RLS were investigated and compared with 10 healthy subjects. In the patient group, we analyzed event-related beta and mu (de)synchronization (ERD/S) for PLMS and PLMW during a suggested immobilization test (SIT). An ERD/S analysis was also performed in patients and controls during self-paced right ankle dorsal flexion at 8:30 PM (i.e., the symptomatic period for patients) and 8:30 AM (the asymptomatic period). RESULTS: Before PLMS, there was no ERD. Intense ERS was recorded after PLMS. As with voluntary movement, cortical ERD was always observed before PLMW. After PLMW, ERS had a diffuse scalp distribution. Furthermore, the ERS and ERD amplitudes and durations for voluntary movement were greater during the symptomatic period than during the asymptomatic period and in comparison with healthy controls, who presented an evening decrease in these parameters. Patients and controls had similar ERD and ERS patterns in the morning. CONCLUSION: On the basis of a rhythm reactivity study, we conclude that the symptoms of RLS are related to cortical sensorimotor dysfunction.

Deficient "sensory" beta synchronization in Parkinson's disease.

OBJECTIVE: Beta rhythm movement-related synchronization (beta synchronization) reflects motor cortex deactivation and sensory afference processing. In Parkinson's disease (PD), decreased beta synchronization after active movement reflects abnormal motor cortex idling and may be involved in the pathophysiology of akinesia. The objectives of the present study were to (i) compare event-related synchronization after active and passive movement and electrical nerve stimulation in PD patients and healthy, age-matched volunteers and (ii) evaluate the effect of levodopa. METHODS: Using a 128-electrode EEG system, we studied beta synchronization after active and passive index finger movement and electrical median nerve stimulation in 13 patients and 12 control subjects. Patients were recorded before and after 150% of their usual morning dose of levodopa. RESULTS: The peak beta synchronization magnitude in the contralateral primary sensorimotor (PSM) cortex was significantly lower in PD patients after active movement, passive movement and electrical median nerve stimulation, compared with controls. Levodopa partially reversed the drop in beta synchronization after active movement but not after passive movement or electrical median nerve stimulation. DISCUSSION: If one considers that beta synchronization reflects sensory processing, our results suggest that integration of somaesthetic afferences in the PSM cortex is abnormal in PD during active and passive movement execution and after simple electrical median nerve stimulation. SIGNIFICANCE: Better understanding of the mechanisms involved in the deficient beta synchronization observed here could prompt the development of new therapeutic approaches aimed at strengthening defective processes. The lack of full beta synchronization restoration by levodopa might be related to the involvement of non-dopaminergic pathways.

Post-movement beta synchronization in subjects presenting with sensory deafferentation.

OBJECTIVE: We studied the time course and location of post-movement beta synchronization (PMBS) in patients presenting with sensory deafferentation, in order to assess the hypothetical relationship between the PMBS and the cortical processing of movement-related somatosensory afferent inputs. METHODS: We used the event-related synchronization (ERS) method. EEG activity was recorded (via a 128-electrode system) during brisk, unilateral right and left index finger extension by 10 patients presenting with neuropathic pain related to sensory deafferentation. Intra- and post-movement changes in beta source power were calculated relative to pre-movement baseline activity. We compared the PMBS results for the painful and non-painful body sides. Furthermore, PMBS patterns in patients were compared with those in nine healthy volunteers. RESULTS: PMBS pattern related to the painful side had a spatial distribution, with an ipsilateral preponderance, significantly more restricted than PMBS pattern on the non-painful side and in the control group. There were no significant differences between patient PMBS patterns on the non-painful side and those in the control group. CONCLUSIONS: Sensory deafferentation disrupts normal PMBS patterns. SIGNIFICANCE: This work provides additional arguments to the hypothesis supporting that the PMBS is influenced by movement-related somatosensory input processing.

Anticipatory postural adjustments associated with arm movement in Parkinson's disease: a biomechanical analysis.

OBJECTIVE: To study anticipatory postural adjustments (APAs) in Parkinson's disease (PD) via a biomechanical analysis, including vertical torque (Tz). METHODS: Ten patients with PD (in the "off-drug" condition) and 10 age matched controls were included. While standing on a force platform, the subject performed a right shoulder flexion in order to grasp a handle in front of him/her, under three conditions (all at maximal velocity): movement triggered by a sound signal and loaded/non-loaded, self-paced movement. The anteroposterior coordinates of the centre of pressure (COP) and Tz were calculated. RESULTS: A group effect was observed for Tz and COP in patients with PD (compared with controls): the maximal velocity peak appeared later and the amplitude of the COP backward displacement and the area of the positive phase of Tz were lower, whereas the duration of the positive phase of Tz was greater. Interaction analysis showed that the area of Tz was especially affected in the triggered condition and the loaded, self-paced condition. The onset of the COP backward displacement was delayed in the triggered condition. CONCLUSION: Our biomechanical analysis revealed that patients with PD do indeed perform APAs prior to unilateral arm movement, although there were some abnormalities. The reduced APA magnitude appears to correspond to a strategy for not endangering postural balance.

Motor representation areas in epileptic patients with focal motor seizures: a TMS study.

PURPOSE: This study used TMS mapping to investigate the motor representation of the abductor pollicis brevis (APB) muscles in a group of patients with focal epilepsy originating in central or pre-central region. METHODS: Eight epileptic patients and eight control subjects participated in the study. The coil was moved in 1.5-cm steps along a grid drawn on the subject's skull over the motor cortex of both hemispheres. At each site, six APB motor responses (evoked by TMS at 1.2 times the resting motor threshold) were recorded and averaged. The peak-to-peak amplitude was measured and plotted against the mediolateral and anteroposterior coil positions. The area of each APB muscle representation was measured and the position of the optimal point was calculated. RESULTS: The resting motor threshold was increased bilaterally in epileptic patients. The maps were distorted in most patients (but not in control subjects), as evidenced by an off-centre optimal point. Interhemispheric differences in APB map areas were greater in patients than in control subjects. However, whether these increases in map area were on the epileptic side or on healthy side depended on the given subject. CONCLUSIONS: The changes in APB representation observed in epileptic patients demonstrate that reorganization occurs within the motor cortex. The heterogeneity of the present results is probably related to different locations of the epileptogenic and/or lesional areas and to a variety of compensatory phenomena that may occur, notably with respect to the disease duration.

[Role of EEG in the diagnosis of brain death]. / Place de l'EEG dans le diagnostic de mort encéphalique.

Brain death diagnosis is based upon several clinical and paraclinical criteria that have been legally defined. There is a medico-legal protocol when brain death diagnosis is made in order to allow organ removal for a possible transplantation. In France, EEG or cerebral arteriography must legally be used to confirm a clinical brain death suspicion. There is a specific procedure to perform an EEG to confirm the diagnosis of brain death. However all the criteria have been made using conventional paper EEG, while numerized is now used. The comparison of EEG recording using both analogical and numerised acquisition allow us to report several recommendations to use EEG for brain death diagnosis.

A biomechanical study of gait initiation in Huntington's disease.

BACKGROUND: Akinesia in basal ganglia disorders is essentially defined by delayed movement initiation; the reaction time increases and it becomes difficult (or even impossible) for the subject to initiate movement. A biomechanical study of gait initiation would help evaluate the role of akinesia in early stage Huntington's disease (HD) patients. METHODS: We recorded kinematic, spatiotemporal and angular parameters (using video motion analysis, a force platform and an optoelectronic system) for the first two steps taken by 15 HD patients and 15 gender- and age-matched controls. In order to evaluate the influence of an external cue on gait initiation parameters, we studied two movement paradigms: self-triggered initiation and initiation triggered (cued) by a "beep" sound. We analyzed kinematic, spatiotemporal (the speed, length and duration of the two first steps) and angular parameters (range of joint angles) as well as kinetic data (the trajectory of the centre of pressure (COP); the speed and trajectory of the centre of mass (COM)). RESULTS: HD patients presented akinesia in both externally triggered and self-triggered conditions. Patients had more difficulties with self-triggered gait than with triggered gait. In HD, anticipatory postural adjustments (APAs) were more impaired in self-triggered gait initiation than in cued initiation. Indeed, an alteration in the kinetic parameters revealed a reduction in first step speed in both conditions. Hypokinesia (as assessed by a reduction in the range of angle joints) played an important role in this reduction. CONCLUSION: Akinesia is a major feature of impaired gait initiation in HD. The deficiencies in self-triggered initiation in HD seen here fit with a hypothesis whereby deficient internal cueing can be replaced by an external trigger.

Movement-related cortical activation in familial Parkinson disease.

We sought to determine whether or not first-degree relatives of patients with familial Parkinson disease (FDRs) present impaired movement-related cortical activity. We studied 10 familial Parkinson disease subjects, 10 FDRs, and 10 controls and analyzed event-related mu desynchronization (ERD) and beta synchronization. Forty percent FDRs presented reduced premovement mu ERD latency, suggesting that premovement cortical activation is impaired in FDRs.

Oscillatory cortical activity related to voluntary muscle relaxation: influence of normal aging.

OBJECTIVE: In this study we aimed to investigate if there are age-related differences in cortical oscillatory activity induced by self-paced muscular pure relaxation in comparison with muscle contraction as reference movement. METHODS: Event-related (de)synchronization (ERD/ERS) have been recorded related to voluntary muscle contraction and relaxation in 10 young and 10 elderly right-handed healthy subjects. The muscle relaxation task consisted in a voluntary relaxation of maintained wrist extension without any overt, associated muscle contraction. The muscle contraction task corresponded to a self-initiated brief wrist extension. RESULTS: In elderly subjects compared to young ones, mu and beta ERD preceding muscular relaxation was more widespread, beginning significantly earlier over contralateral frontocentral and parietocentral regions (p<0.05) as well as over ipsilateral regions (p<0.05). The beta synchronization was significantly attenuated (p<0.05). CONCLUSIONS: These results suggest an alteration of inhibitory motor systems and an altered post-movement somesthetic inputs processing with normal aging. These alterations were accompanied by compensatory mechanisms. SIGNIFICANCE: These age-related alterations during different phases of muscle relaxation could participate to explain global sensorimotor slowing observed with normal aging.

Predominance of the contralateral movement-related activity in the subthalamo-cortical loop.

OBJECTIVE: Abnormal low- and high-frequency oscillatory activities have been linked to abnormal movement control in Parkinson's disease. We aimed to study how low- and high-frequency oscillatory activities are modulated by movement in the contralateral and ipsilateral subcorticocortical loops. METHODS: We studied mu, beta and gamma rhythm event-related desynchronisation (ERD) and synchronisation (ERS) recorded from electrode contacts in the subthalamic nucleus (STN) areas and over the primary sensorimotor (PSM) cortex. RESULTS: Mu and beta ERD/ERS patterns were very similar when comparing PSM cortex and STN areas and very different when comparing contralateral and ipsilateral structures. Beta rhythm ERS was more predominant over contralateral structures than over ipsilateral ones. Gamma rhythm ERS was only recorded from the contralateral STN area (particularly following administration of L-Dopa). For all patients, the best bipolar derivations - as defined by the earliest mu and beta ERD and the strongest beta and gamma ERS - always included the STN electrode contacts that produced the best clinical results. CONCLUSIONS: Movement-related activity is involved in the movement preparation in the contralateral subthalamo-cortical loop and in the movement execution in the bilateral subthalamo-cortical loops. SIGNIFICANCE: Contralateral beta rhythm ERD seemed to be related to bradykinesia of the limb performing the movement.

Gait abnormalities induced by acquired bilateral pallidal lesions: a motion analysis study.

BACKGROUND: Bilateral pallidal lesions induce a range of cognitive and motor disorders, principally a parkinsonian syndrome in which severe disturbances of gait and gait initiation are frequently reported. However, the precise clinical features of these disorders (and the role of the pallidum therein) remain to be established. OBJECTIVES: The goal of this study was to characterise gait and gait initiation disorders within the context of a parkinsonian syndrome in patients with acquired, bilateral, pallidal lesions (PAL patients), to compare these disorders to those seen in Parkinson's disease (PD), and to assess the corresponding physiopathological implications. PATIENTS AND METHODS: By using a video motion analysis system (VICON), we studied gait kinematic parameters in two patients presenting with bilateral, pallidal lesions. Kinematic and kinetic parameters were also determined during gait initiation. The two patients were compared with a group of 17 PD patients and to 20 healthy controls. RESULTS: In both PAL and PD patients, kinematic parameters (gait and gait initiation) and kinetic parameters (gait initiation) were similarly impaired, evidenced by akinesia (difficulty in initiating gait characterized by impairment of anticipatory postural adjustments). Hypokinesia and bradykinesia (respectively reduced stride length and reduced speed during gait) were also noted. CONCLUSION: The gait and gait initiation disorders seen in cases of bilateral pallidal lesions (namely akinesia, hypokinesia and bradykinesia) are similar to those observed in PD. Subject to confirmation in more extensive studies, we hypothesize that bipallidal patients may present higher level gait disorders,with potential mediation by cognitive impairment.

Relationship between event-related beta synchronization and afferent inputs: analysis of finger movement and peripheral nerve stimulations.

OBJECTIVE: We compared beta synchronization associated with voluntary finger movement with beta synchronization produced by sensory stimulation, in order to better understand the relationship between event-related beta synchronization (ERS) and the different afferent inputs. METHODS: Twenty-four subjects performed an index finger extension. They also received three types of electrical stimulation (cutaneous stimulation of the index finger, single and repetitive stimulation of the median nerve). An EEG was recorded using 38 scalp electrodes. Beta ERS was analyzed with respect to movement offset and the stimulus (or the last stimulus in the series, for repetitive stimulation). RESULTS: Median nerve stimulation and finger extension induced more intense beta ERS than cutaneous stimulation. The magnitude of beta ERS induced by movement or by single median nerve stimulation were not different but post movement beta synchronization duration was longer than beta ERS induced by single median nerve stimulation and cutaneous stimulation. CONCLUSIONS: This study demonstrates that beta ERS depends on the type and quantity of the afferent input. SIGNIFICANCE: This work reinforces the hypothesis of a relationship between beta ERS and processing of afferent inputs.

[Pathophysiological mechanisms implicated by high-frequency stimulation in Parkinson's disease: the restoration of high and low frequency oscillatory systems]. / Mécanismes physiopathologiques de la stimulation à haute fréquence dans la maladie de Parkinson: restauration des systèmes oscillatoires de haute et basse fréquences.

INTRODUCTION: Increased neuronal activity in the internal pallidum (GPi) and the subthalamic nucleus (STN) has been clearly demonstrated in Parkinsonian models, and the two structures have thus been selected as therapeutic targets for functional neurosurgery. High-frequency electrical stimulation of the GPi or the STN improves the parkinsonian symptoms but also dyskinesias directly by GPi stimulation or indirectly by reduction of L-Dopa associated with STN stimulation. According to Alexander's model of the organisation of the basal ganglia, electrical stimulation of GPi or STN should have led to uncontrolled hyperkinesia. This apparent paradox could be explained on one hand by the involvement of different anatomo-functional areas within these structures and on the other by spatial and temporal changes in neuronal discharge patterns in the basal ganglia which in turn produce variations in synchronisation. RESULTS: Event-related (de)synchronisation (ERD) has enabled us to study variations in subcortico-cortical oscillatory activity: it has been shown that high-frequency electrical stimulation of the GPi/STN increases desynchronisation of low frequency rhythms (mu and beta,<30 Hz) during movement preparation and execution and augments post-movement synchronisation. Stimulation also decreases the abnormal frontocentral spreading of desynchronisation during movement preparation. CONCLUSIONS: In accordance with previous coherence analyses, electrical stimulation of STN is likely to restore the activity of high-frequency and low-frequency systems, as evidenced by a decrease in the hypersynchronisation of low-frequency rhythms at rest and restoral of a high-frequency rhythm during movement. Stimulation may improve spatial selectivity by activating the selected programs in conjunction with the primary sensorimotor cortex, whilst inhibiting competitive programs represented by abnormal spreading outside the primary sensorimotor cortex.

Disturbance of sensory filtering in dementia with Lewy bodies: comparison with Parkinson's disease dementia and Alzheimer's disease.

INTRODUCTION: Prepulse inhibition (PPI) is considered to mirror an organism's ability to filter out irrelevant sensory or cognitive information. The disruption of PPI has never been studied in individuals suffering from dementia with Lewy bodies (DLB). As attention deficits largely contribute to cognitive impairment in DLB, an investigation with a PPI paradigm is useful for differential diagnosis of DLB versus Alzheimer's disease (AD) and Parkinson's disease dementia (PDD). OBJECTIVE AND METHODS: PPI of the N1/P2 component of auditory evoked potentials was used to investigate the early stages of attention selectivity in 10 DLB, 10 AD, and 10 PDD patients, as well as in 10 healthy controls. The PPI paradigm consisted of the presentation of sound pulses (40 ms, 115 dB) preceded by a prepulse (40 ms, 80 dB). Sound stimuli were presented in a total of 80 trials in a pseudo-random order. RESULTS: Non-parametric analyses of variance revealed a significant group effect on the 120 ms lead interval. Retrospective analyses revealed that PPI was significantly reduced in DLB compared to healthy controls and AD. In the PDD group, the disturbance was of intermediate intensity. CONCLUSION: The present study revealed a severe disturbance of PPI in DLB patients. The DLB patients displayed a specific disruption profile in terms of magnitude as well as time course.

Statistical tools for clinical gait analysis.

Gait analysis studies involve continuous curves of data measured over a gait cycle. Curve analysis and interpretation require adequate statistical methods. Three principal problems may be encountered in clinical practice: (i) the reliability of gait curves for a given patient, (ii) classifying a new subject as belonging to a given population or not and (iii) comparison of two populations (independent or paired). This paper presents three statistical tools for solving these problems: (i) intra-class correlation coefficients, (ii) confidence bands for a population (iii) a combination of analysis of variance and confidence bands for the difference between the means and shows how they can be used in clinical practice.

Influence of aging on cortical activity associated with a visuo-motor task.

The aim of this study was to determine how cerebral aging influences the pattern of cortical oscillatory activity when a targeting movement with visual control is planned. Changes in cortical oscillatory activity were assessed by recording the event-related (de)synchronization (ERD/S) of micro and beta rhythms. Young and elderly subjects performed a distal movement, a proximal movement and a visuo-guided targeting movement. Our results demonstrated an increase in micro ERD over ipsilateral regions and showed the spatial extent of micro ERD over parietocentral and parietal regions during motor planning in elderly subjects compared to young ones. After the movement, the beta ERS was significantly modified (a decrease in slope and amplitude) in elderly subjects. The most pronounced age-related changes in ERD/S pattern were observed for the targeting movement. Our results suggest that motor planning is less efficient in elderly subjects. This deficit might result from impaired parietal integrative function and/or changes in inputs from subcortical structures. Subsequently, the changes observed in the post-movement phase might reflect a decrease in (reafferent) sensory inputs and hence impaired their input processing.