Gait analysis and cerebral volumes in Down's syndrome.

The aim of this study was to look for a relationship between cerebral volumes computed using a voxel-based morphometry algorithm and walking patterns in individuals with Down's syndrome (DS), in order to investigate the origin of the motor problems in these subjects with a view to developing appropriate rehabilitation programmes. Nine children with DS underwent a gait analysis (GA) protocol that used a 3D motion analysis system, force plates and a video system, and magnetic resonance imaging (MRI). Analysis of GA graphs allowed a series of parameters to be defined and computed in order to quantify gait patterns. By combining some of the parameters it was possible to obtain a 3D description of gait in terms of distance from normal values. Finally, the results of cerebral volume analysis were compared with the gait patterns found. A strong relationship emerged between cerebellar vermis volume reduction and quality of gait and also between grey matter volume reduction of some cerebral areas and asymmetrical gait. An evaluation of high-level motor deficits, reflected in a lack or partial lack of proximal functions, is important in order to define a correct rehabilitation programme.

Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension.

Exercise tolerance inversely correlates with the severity of the disease in patients with idiopathic pulmonary arterial hypertension (IPAH). Cycling and walking protocols are commonly utilized in the evaluation of exercise intolerance in IPAH, but little information exists on possible differences in ventilatory and gas exchange adaptations to these exercise modalities. In a group of patients with moderate to severe IPAH (n = 13), we studied the ventilatory, cardiovascular and gas exchange adaptations to maximal incremental walking (W) and maximal incremental cycling (C). During W, compared to C, the ventilatory equivalents for CO(2) output (V'(E)/V'CO(2)) were significantly higher either expressed as the rate of increment (56 +/- 5 vs. 45 +/- 3; P < 0.0001) or as the absolute values at anaerobic threshold (AT) and at peak exercise. At AT, the increase in V'(E)/V'CO(2) during W was associated with a significant lower value of end-tidal carbon dioxide. At peak W, compared to peak C, dyspnea sensation was higher and arterial oxygen saturation (SpO(2)) was lower (87 +/- 2 vs. 91 +/- 2, P < 0.001). In patients with IPAH the physiologic information obtained with W are different from those obtained with C. Tolerance to W exercise is limited by high ventilatory response and dyspnea sensation. W should be used to assess the degree of lung gas exchange inefficiency and arterial O(2) desaturation during exercise.

Temporal lobe epilepsy surgery: different surgical strategies after a non-invasive diagnostic protocol.

AIM: To test a non-invasive presurgical protocol for temporal lobe epilepsy (TLE) based on "anatomo-electro-clinical correlations". METHODS: All consecutive patients with suspected TLE and seizure history <2 years were entered into the protocol, which included video-electroencephalographic (EEG) monitoring and magnetic resonance imaging (MRI). Three different TLE subsyndromes (mesial, lateral, mesiolateral) were identified by combined anatomical, electrical, and clinical criteria. "Tailored" surgery for each subsyndrome was offered. Patients with seizure history <2 years, MRI evidence of temporal mass lesion, and concordant interictal EEG and clinical data bypassed video-EEG monitoring and were directly scheduled for surgery. RESULTS: Lesionectomy was performed without video-EEG recording in 11 patients with tumorous TLE. Of 146 patients studied with video-EEG, 133 received a TLE diagnosis. Four were excluded for neuropsychological risks, eight refused surgery, and 121 underwent surgery. Of 132 consecutive patients who underwent surgery, 101 had at least one year of follow up. They were divided into a "hippocampal sclerosis/cryptogenic" group (n = 57) and a "tumours/cortical organisation disorders" group (n = 44). In the first group, extensive temporal lobectomy (ETL) was performed in 40 patients, anteromesial temporal lobectomy (AMTL) in 17 patients. At follow up, 47 patients were seizure free. In the second group, lesionectomy plus ETL was performed in 23 patients, lesionectomy plus AMTL in six patients, and lesionectomy alone in 15 patients. Thirty nine patients were seizure free. CONCLUSIONS: These findings suggest that different TLE subsyndromes can be identified accurately using non-invasive anatomo-electro-clinical data and can be treated effectively and safely with tailored surgery.

CD4(+) T-lymphocytopenia and Pneumocystis carinii pneumonia in a patient with miliary tuberculosis.

We report a case of miliary tuberculosis (MTB) occurring after extracorporeal shock-wave lithotripsy in a 51-year-old man. The MTB was complicated by pancytopenia and CD4(+) T-lymphocytopenia, which was responsible for Pneumocystis carinii pneumonia. Hematological parameters returned to normal in response to antituberculous treatment.

Early coding of visuomanual coordination during reaching in parietal area PEc.

The parietal mechanisms of eye-hand coordination during reaching were studied by recording neural activity in area PEc while monkeys performed different tasks, aimed at assessing the influence of retinal, hand-, and eye-related signals on neural activity. The tasks used consisted of 1) reaching to foveated and 2) to extra-foveal targets, with constant eye position; and 3) saccadic eye movement toward, and holding of eye position on peripheral targets, the same as those of the reaching tasks. In all tasks, hand and/or eye movements were made from a central position to eight peripheral targets. A conventional visual fixation paradigm was used as a control task, to assess location and extent of visual receptive field of neurons. A large proportion of cells in area PEc displayed significant relationships to hand movement direction and position. Many of them were also related to the eye's position. Relationships to saccadic eye movements were found for a smaller proportion of cells. Most neurons were tuned to different combination of hand- and eye-related signals; some of them were also influenced by visual information. This combination of signals can be an expression of the early stages of the composition of motor commands for different forms of visuomotor coordination that depend on the integration of hand- and eye-related information. These results assign to area PEc, classically considered as a somatosensory association cortex, a new visuomotor role.

Ventilatory and metabolic adaptations to walking and cycling in patients with COPD.

To test the hypothesis that in chronic obstructive pulmonary disease (COPD) patients the ventilatory and metabolic requirements during cycling and walking exercise are different, paralleling the level of breathlessness, we studied nine patients with moderate to severe, stable COPD. Each subject underwent two exercise protocols: a 1-min incremental cycle ergometer exercise (C) and a "shuttle" walking test (W). Oxygen uptake (VO(2)), CO(2) output (VCO(2)), minute ventilation (VE), and heart rate (HR) were measured with a portable telemetric system. Venous blood lactates were monitored. Measurements of arterial blood gases and pH were obtained in seven patients. Physiological dead space-tidal volume ratio (VD/VT) was computed. At peak exercise, W vs. C VO(2), VE, and HR values were similar, whereas VCO(2) (848 +/- 69 vs. 1,225 +/- 45 ml/min; P < 0. 001) and lactate (1.5 +/- 0.2 vs. 4.1 +/- 0.2 meq/l; P < 0.001) were lower, DeltaVE/DeltaVCO(2) (35.7 +/- 1.7 vs. 25.9 +/- 1.3; P < 0. 001) and DeltaHR/DeltaVO(2) values (51 +/- 3 vs. 40 +/- 4; P < 0.05) were significantly higher. Analyses of arterial blood gases at peak exercise revealed higher VD/VT and lower arterial partial pressure of oxygen values for W compared with C. In COPD, reduced walking capacity is associated with an excessively high ventilatory demand. Decreased pulmonary gas exchange efficiency and arterial hypoxemia are likely to be responsible for the observed findings.

Early coding of reaching in the parietooccipital cortex.

Neural activity was recorded in the parietooccipital cortex while monkeys performed different tasks aimed at investigating visuomotor interactions of retinal, eye, and arm-related signals on neural activity. The tasks were arm reaching 1) to foveated targets; 2) to extrafoveal targets, with constant eye position; 3) within an instructed-delayed paradigm, under both light and darkness; 4) saccadic eye movements toward, and static eye holding on peripheral targets; and 5) visual fixation and stimulation. The activity of many cells was modulated during arm reaction (68%) and movement time (58%), and during static holding of the arm in space (64%), when eye position was kept constant. Eye position influenced the activity of many cells during hand reaction (45%) and movement time (51%) and holding of hand static position (69%). Many cells (56%) were also modulated during preparation for hand movement, in the delayed reach task. Modulation was present also in the dark in 59% of cells during this epoch, 51% during reaction and movement time, and 48% during eye/hand holding on the target. Cells (50%) displaying light-dark differences of activity were considered as related to the sight and monitoring of hand motion and/or position in the visual field. Saccadic eye movements modulated a smaller percentage (25%) of cells than eye position (68%). Visual receptive fields were mapped in 44% of the cells studied. They were generally large and extended to the periphery of the tested (30 degrees ) visual field. Sixty-six percent of cells were motion sensitive. Therefore the activity of many neurons in this area reflects the combined influence of visual, eye, and arm movement-related signals. For most neurons, the orientation of the preferred directions computed across different epochs and tasks, therefore expression of all different eye- and hand-related activity types, clustered within a limited sector of space, the field of global tuning. These spatial fields might be an ideal frame to combine eye and hand signals, thanks to the congruence of their tuning properties. The relationships between cell activity and oculomotor and visuomanual behavior were task dependent. During saccades, most cells were recruited when the eye moved to a spatial location that was also target for hand movement, whereas during hand movement most cells fired depending on whether or not the animal had prior knowledge about the location of the visual targets.

Pulmonary gas exchange and exercise capacity in patients with systemic lupus erythematosus.

OBJECTIVE: Exercise tolerance is often reduced in patients with systemic lupus erythematosus (SLE). Mechanisms have been proposed but the underlying causes have not yet been elucidated. The study of pulmonary gas exchange during exercise may be helpful in revealing circulatory, ventilatory, and metabolic abnormalities. We hypothesized that in SLE, exercise aerobic capacity would be reduced due to chronic inactivity and poor muscle energetics. METHODS: Thirteen women with SLE and low disease activity were studied; 5 age matched subjects served as controls. Clinical examination, chest radiography, electrocardiogram, and pulmonary function test were all normal. Subjects underwent 1 min incremental cycle ergometer exercise to exhaustion. Oxygen uptake (VO2), CO2 output (VCO2), minute ventilation (VE), heart rate (HR), and arterial O2 saturation were monitored. Anaerobic threshold (AT), VO2/HR, deltaVO2/deltaWatt, respiratory rate (RR), Ti/Ttot, VE/VCO2, and breathing reserve (BR) were computed. RESULTS: At rest, patients exhibited high VE, respiratory alkalosis, and a wide alveolar-arterial O2 gradient [(A - a)O2] during 50% O2 breathing. Other indexes of respiratory function were within the normal range. In the 6 patients with SLE where pulmonary artery systolic pressure at Doppler echocardiography was measurable, mean level was in the upper limits of normal. During exercise, maximal aerobic capacity was reduced in all patients (VO2 peak, 1098+/-74 vs. 2150+/-160 ml/min, p<0.01; AT, 36 +/-3 vs. 48+/-3% predicted VO2 max, p<0.05). Ventilation adjusted for the metabolic demand (VE/VCO2 at AT) was increased (31+/-1 vs. 24+/-1; p<0.05). A normal breathing pattern was observed during all tests. No patient stopped exercising because of ventilatory limitation (i.e., they had normal breathing reserve). CONCLUSION: Reduced muscle aerobic capacity is common in SLE and is most likely because of peripheral muscle deconditioning. Increased ventilatory demand, secondary to diffuse interstitial lung disease, is not a significant contributor to the reduction in exercise tolerance.

"Gating" of human short-latency somatosensory evoked cortical responses during execution of movement. A high resolution electroencephalography study.

The present study aimed at investigating gating of median nerve somatosensory evoked cortical responses (SECRs), estimated during executed continuous complex ipsilateral and contralateral sequential finger movements. SECRs were modeled with an advanced high resolution electroencephalography technology that dramatically improved spatial details of the scalp recorded somatosensory evoked potentials. Integration with magnetic resonance brain images allowed us to localize different SECRs within cortical areas. The working hypothesis was that the gating effects were time varying and could differently influence SECRs. Maximum statistically significant (p<0. 01) time-varying gating (magnitude reduction) of the short-latency SECRs modeled in the contralateral primary motor and somatosensory and supplementary motor areas was computed during the executed ipsilateral movement. The gating effects were stronger on the modeled SECRs peaking 30-45 ms (N30-P30, N32, P45-N45) than 20-26 ms (P20-N20, P22, N26) post-stimulus. Furthermore, the modeled SECRs peaking 30 ms post-stimulus (N30-P30) were significantly increased in magnitude during the executed contralateral movement. These results may delineate a distributed cortical sensorimotor system responsible for the gating effects on SECRs. This system would be able to modulate activity of SECR generators, based on the integration of afferent somatosensory inputs from the stimulated nerve with outputs related to the movement execution.

Early coding of reaching: frontal and parietal association connections of parieto-occipital cortex.

The ipsilateral association connections of the cortex of the dorsal part of the rostral bank of the parieto-occipital sulcus and of the adjoining posterior part of the superior parietal lobule were studied by using different retrograde fluorescent tracers. Fluoro-Ruby, Fast blue and Diamidino yellow were injected into visual area V6A, and dorso-caudal (PMdc, F2) and dorso-rostral (PMdr, F7) premotor cortex, respectively. The parietal area of injection had been previously characterized physiologically in behaving monkeys, through a variety of oculomotor and visuomanual tasks. Area V6A is mainly linked by reciprocal projections to parietal areas 7m, MIP (medial intraparietal) and PEa, and, to a lesser extent, to frontal areas PMdr (rostral dorsal premotor cortex, F7) and PMdc (F2). All these areas project to that part of the dorsocaudal premotor cortex that has a direct access to primary motor cortex. V6A is also connected to area F5 and, to a lesser extent, to 7a, ventral (VIP) and lateral (LIP) intraparietal areas. This pattern of association connections may explain the presence of visually-related and eye-position signals in premotor cortex, as well as the influence of information concerning arm position and movement direction on V6A neural activity. Area V6A emerges as a potential 'early' node of the distributed network underlying visually-guided reaching. In this network, reciprocal association connections probably impose, through re-entrant signalling, a recursive property to the operations leading to the composition of eye and hand motor commands.

Responses of human primary sensorimotor and supplementary motor areas to internally triggered unilateral and simultaneous bilateral one-digit movements. A high-resolution EEG study.

We modelled the responses of human primary sensorimotor areas and supplementary motor area to simple, self-initiated unilateral and simultaneous bilateral middle finger movements using a novel high-resolution electroencephalography technology. The results support the view that these cortical motor areas are involved in parallel and present similar activity in the preparation, initiation, and execution of the contralateral and bilateral movements. Furthermore, the left primary sensorimotor area (dominant hemisphere) appears to be activated more than the right primary sensorimotor area during the preparation and performance of the ipsilateral movements.

Dynamic functional coupling of high resolution EEG potentials related to unilateral internally triggered one-digit movements.

Between-electrode cross-covariances of delta (0-3 Hz)- and theta (4-7 Hz)-filtered high resolution EEG potentials related to preparation, initiation. and execution of human unilateral internally triggered one-digit movements were computed to investigate statistical dynamic coupling between these potentials. Significant (P < 0.05, Bonferroni-corrected) cross-covariances were calculated between electrodes of lateral and median scalp regions. For both delta- and theta-bandpassed potentials, covariance modeling indicated a shifting functional coupling between contralateral and ipsilateral frontal-central-parietal scalp regions and between these two regions and the median frontal-central scalp region from the preparation to the execution of the movement (P < 0.05). A maximum inward functional coupling of the contralateral with the ipsilateral frontal-central-parietal scalp region was modeled during the preparation and initiation of the movement, and a maximum outward functional coupling during the movement execution. Furthermore, for theta-bandpassed potentials, rapidly oscillating inward and outward relationships were modeled between the contralateral frontal-central-parietal scalp region and the median frontal-central scalp region across the preparation, initiation, and execution of the movement. We speculate that these cross-covariance relationships might reflect an oscillating dynamic functional coupling of primary sensorimotor and supplementary motor areas during the planning, starting, and performance of unilateral movement. The involvement of these cortical areas is supported by the observation that averaged spatially enhanced delta- and theta-bandpassed potentials were computed from the scalp regions where task-related electrical activation of primary sensorimotor areas and supplementary motor area was roughly represented.

Effect of reduced body weight on muscle aerobic capacity in patients with COPD.

BACKGROUND: Reduced muscle aerobic capacity in COPD patients has been demonstrated in several laboratories by phosphorus magnetic resonance spectroscopy and by analysis of oxygen uptake (VO2) kinetics. COPD patients are usually elderly, hypoxemic, poorly active with muscle atrophy, and often malnourished. Under these conditions there is usually reduction of O2 delivery to the tissues (bulk O2 flow), redistribution of fiber type within the muscle, capillary rarefaction, and decreased mitochondrial function, alterations all capable of reducing muscle aerobic capacity. In COPD, the effect of reduced body mass on muscle aerobic capacity has not been investigated (to our knowledge). METHODS: We studied 24 patients with stable COPD with moderate-to-severe airway obstruction (68+/-5 [SD] years; FEV1, 39+/-12% predicted; PaO2, 66+/-8 mm Hg; PaCO2, 41+/-3 mm Hg) with poor to normal nutritional status, as indicated by a low-normal percent of ideal body weight (IBW). Each subject first underwent 1-min maximal incremental cycle ergometer exercise for determination of VO2 peak and lactate threshold (LT). Subsequently, they performed a 10-min moderate (80% of LT-VO2) constant load exercise for determination of oxygen deficit (O2DEF) and mean response time VO2 (MRT). VO2, CO2 output (VCO2), and minute ventilation were measured breath by breath. RESULTS: Patients displayed low VO2 peak (1,094+/-47 [SE] mL/min), LT-VO2 (35+/-3% predicted O2 max), and higher MRT-VO2 (67+/-4 s). Univariate regression analysis showed that percent of IBW correlated with indexes of maximal and submaximal aerobic capacity: vs VO2 peak, R=0.53 (p<0.01); vs MRT R=-0.77 (p<0.001). Using stepwise regression analysis, MRT correlated (R2=-0.70) with percent of IBW (p<0.01) and with PaO2 (p<0.05). CONCLUSIONS: Reduced body mass has an independent negative effect on muscle aerobic capacity in COPD patients: this effect may explain the variability in exercise tolerance among patients with comparable ventilatory limitation.

Human short latency cortical responses to somatosensory stimulation. A high resolution EEG study.

Human short-latency cortical responses to median nerve stimulation were investigated with a new high resolution electroencephalography technology that markedly enhanced spatial details of somatosensory-evoked potentials (SEPs). Maximum amplitude potentials were estimated over contralateral and/or frontal-mesial scalp regions about 20, 22, 24, 26, 30, 32 and 45 ms following the stimulation. Frontal-lateral P20-N24-N30-P45 and parietal-lateral N20-P24-P30-N45 showed dipolar patterns, whereas frontal-mesial N24-N30-P45 and central-lateral P22-N26-N32-P45 presented no clearcut dipole counterpart. Plausibly, the spatially enhanced frontal-parietal SEP components were generated (tangential dipoles) within the lateral central sulcus cortex, and anticipated the central-lateral and frontal-mesial components generated (radial dipoles) from the crown of the pre- and/or post-central gyri and the supplementary motor area, respectively.

A high resolution EEG method based on the correction of the surface Laplacian estimate for the subject's variable scalp thickness.

To improve the spatial resolution of human event-related potentials, we developed a new high resolution EEG method based on the improved estimate of the realistic surface Laplacian (SL). The novelty of this method consisted in the computation of the local scalp resistance that was assumed to be inversely proportional to the local scalp thickness measured from magnetic resonance images of the subject's head. The local scalp thickness was then multiplied by the SL estimate of the potential over a realistic magnetic resonance-constructed model of the subject's scalp surface. The new method was applied on human movement-related and somatosensory-evoked potentials, the SL estimate at a constant scalp thickness being used as a reference. The locally-predicted scalp thickness was significantly (P < 0.05) higher in the temporal areas (9.5 +/- 2.6 mm) than in the parieto-occipital (6.6 +/- 1.3 mm) and frontal (4.8 +/- 1.1 mm) areas. Compared to the SL estimate at constant scalp thickness, the improved SL estimate enhanced the spatial detail of both movement-related and somatosensory-evoked potentials.

Topography of spatially enhanced human short-latency somatosensory evoked potentials.

In the present study modern high resolution electroencephalography (EEG) was used to spatially enhance human median nerve short-latency somatosensory evoked potentials (SEPs). It was shown that the spatially enhanced N30 consisted of two frontal subcomponents, one located in the frontal-lateral area of the scalp, the other located in the frontal-mesial area. Both of these subcomponents were most reduced in amplitude (or disappeared) during concomitant hand movement ipsilateral to the stimulus, but were differentially influenced by executed contralateral movement and imagined ipsilateral movement. These results support the hypothesis of an involvement of the frontal-mesial cortex (including the supplementary motor area) in the generation of the frontal N30.

High resolution EEG: a new model-dependent spatial deblurring method using a realistically-shaped MR-constructed subject's head model.

This paper presents a new model-dependent method for the spatial deblurring of scalp-recorded EEG potentials based on boundary-element and cortical imaging techniques. This model-dependent spatial deblurring (MDSD) method used MR images for the reconstruction of the subject's head model, and a layer of 364 radially-oriented equivalent current dipoles as a source model. The validation of the MDSD method was performed on simulated potential distributions generated from equivalent dipoles oriented radially, obliquely, and tangentially to the head surface. Furthermore, this method was used to localize neocortical sources of human movement-related and somatosensory-evoked potentials. It was shown that the new MDSD method improved markedly the spatial resolution of the simulated surface potentials and scalp-recorded event-related potentials. The spatial information content of the scalp-recorded EEG potentials increased progressively by increasing the spatial sampling from 28 to 128 channels. These results indicate that the new method could be satisfactorily used for high resolution EEG studies.

Human cortical activity related to unilateral movements. A high resolution EEG study.

In the present study a modern high resolution electroencephalography (EEG) technique was used to investigate the dynamic functional topography of human cortical activity related to simple unilateral internally triggered finger movements. The sensorimotor area (M1-S1) contralateral to the movement as well as the supplementary motor area (SMA) and to a lesser extent the ipsilateral M1-S1 were active during the preparation and execution of these movements. These findings suggest that both hemispheres may cooperate in both planning and production of simple unilateral volitional acts.

Spline Laplacian estimate of EEG potentials over a realistic magnetic resonance-constructed scalp surface model.

This paper presents a realistic Laplacian (RL) estimator based on a tensorial formulation of the surface Laplacian (SL) that uses the 2-D thin plate spline function to obtain a mathematical description of a realistic scalp surface. Because of this tensorial formulation, the RL does not need an orthogonal reference frame placed on the realistic scalp surface. In simulation experiments the RL was estimated with an increasing number of "electrodes" (up to 256) on a mathematical scalp model, the analytic Laplacian being used as a reference. Second and third order spherical spline Laplacian estimates were examined for comparison. Noise of increasing magnitude and spatial frequency was added to the simulated potential distributions. Movement-related potentials and somatosensory evoked potentials sampled with 128 electrodes were used to estimate the RL on a realistically shaped, MR-constructed model of the subject's scalp surface. The RL was also estimated on a mathematical spherical scalp model computed from the real scalp surface. Simulation experiments showed that the performances of the RL estimator were similar to those of the second and third order spherical spline Laplacians. Furthermore, the information content of scalp-recorded potentials was clearly better when the RL estimator computed the SL of the potential on an MR-constructed scalp surface model.