The effect of an energy drink containing glucose and caffeine on human corticospinal excitability.

Glucose- and caffeine-containing energy drinks are said to influence the cognitive and cellular function within the brain. In this study, we have used the size of motor-evoked potentials (MEPs) produced in response to transcranial magnetic stimulation (TMS) of the motor cortex as an index of corticospinal excitability after ingestion of Lucozade and control drinks of glucose-containing or caffeine-containing carbonated water or carbonated water alone. With local ethical approval and informed consent, 10 healthy volunteers took part; surface electromyographic (EMG) recordings were taken from the thenar muscles of the dominant hand. In each assessment, 15 TMS stimuli were delivered over the motor cortex at an intensity of 1.1 T. Six subjects ingested a 380-ml bottle of carbonated Lucozade drink containing 68 g of glucose and 46 mg caffeine. Four subjects took part in three control trials drinking: (A) carbonated water with caffeine, (B) carbonated water with glucose and (C) carbonated water alone. Assessments were made before and at 30-min intervals after each drink. Mean fasting blood glucose concentrations and mean areas of MEPs rose after the Lucozade, remaining elevated for 90 min. Similar rises in MEP areas were seen in trials after drinking carbonated water with caffeine or with glucose, but not after drinking carbonated water alone. No change was seen in the M-wave evoked by electrical stimulation of the ulnar nerve. We conclude that Lucozade can affect the size of MEPs to activation of the motor cortex with fixed-intensity TMS. The underlying mechanism is likely to relate to the combined effects of caffeine and glucose on the brain.

A correlation between HLA-C matching and donor antirecipient CTL precursor frequency in bone marrow transplantation.

A newly developed, reliable, DNA-based method for typing for alleles of the HLA-C locus has been applied in the context of unrelated, volunteer donors for bone marrow transplantation. Some donors matched for HLA-A, -B, -DR, and -DQ have been found to generate in vitro high frequencies of CTL reactive with the recipient's cells. Here we demonstrate that there is a highly significant correlation of the frequencies of CTL precursors and incompatibility at the HLA-C locus. These data indicate that HLA-C locus incompatibility should be avoided in unrelated donor bone marrow transplantation.

Renal transplantation following immunoadsorption in highly sensitized recipients.

Five highly sensitized patients, with panel reactivity greater than 80% for 1.75-5 years, were treated by extracorporeal staphylococcal protein-A immunoadsorption, prednisolone, and cyclophosphamide. The five patients underwent treatment of 18-40 (mean 31) liters of plasma, respectively in 4-7 (mean 5.6) sessions. This reduced the titer of cytotoxic antibodies to sensitizing antigens to < 1/8 in all cases and abolished reactivity to crossreacting antigens. Two patients required retreatment following resynthesis of cytotoxic antibodies. All five patients have been transplanted, and four of these now have stable serum creatinines of 168 mumol/L at 34 months, 208 mumol/L at 29 months, 96 mumol/L at 5 months, and 125 mumol/L at 3 months posttransplantation. One patient had primary graft dysfunction due to acute tubular necrosis; the kidney was removed after eight weeks and showed cortical necrosis without evidence of acute rejection.

C4 complement allotypes in juvenile dermatomyositis.

Twenty probands with juvenile dermatomyositis and their relatives were studied to determine the inherited segregation patterns of class I, II, and III HLA region markers including C4A, C4B, Bf, and C2 complement polymorphisms. The extended haplotype B8, DR3, C4A*Q0, C4B*1, C2*C, and Bf*S was present in 13 of the 20 probands. Three other probands also carried a haplotype with a null allele for C4A and two further probands carried a null allele for C4B; only two probands had no detectable C4 null allele. These data confirm previous studies showing high frequencies of B8 and DR3 in patients with juvenile dermatomyositis, but show that there is a higher association with null alleles of C4. This suggests that the C4 genes are either themselves the disease-susceptibility genes or are in very strong linkage disequilibrium with such genes.

Segmental influence of slowly-adapting cutaneous mechanoreceptors on gamma motoneurones revealed by cross-correlation of unit discharges in the cat.

Cross-correlations between the discharges of individual cutaneous afferents and gamma motoneurones have been constructed in the spinal, decerebrated cat. The discharges of single receptors in the sural nerve field from the heel were recorded in dorsal root ganglia. Background discharges of gamma motoneurones and the responses to heel stimulation were recorded from cut filaments of the muscle nerve to gastrocnemius medialis of the same leg. Slowly-adapting afferents were stimulated by steady application of a probe to the receptive field whereas rapidly-adapting afferents required continuous movement to sustain discharge of a receptor. Cross-correlation between the discharges of 17 out of 39 slowly-adapting, type-1 (SA1) mechanoreceptors and gamma motoneurones revealed sharp increases in probability of gamma motoneurone discharge that were delayed with respect to the afferent discharge. The peaks were of short duration with widths at half maximum in the range 2-7 ms and rise times of 1 to 4 ms. Deducting peripheral conduction times gave central delays of 3-6.5 ms for gamma motoneurone facilitation. These delays were comparable to those of gamma motoneurone excitation seen in response to electrical stimulation of the sural nerve at 1.5 to 4 times threshold. No short duration peaks were seen in correlograms between hair follicle (n = 29) or slowly-adapting type-2 (SA2) (n = 11) afferents and gamma motoneurones. It is concluded that a single impulse from a SA1 afferent from the hairy skin of the heel is able to facilitate the discharge of gamma motoneurones to the ipsilateral gastrocnemius muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytotoxic T lymphocyte precursor (CTL-p) frequency analysis in unrelated donor bone marrow transplantation: two case studies.

HLA 'matched' unrelated donor bone marrow transplantation (BMT) is associated with an increased incidence and severity of acute graft-versus-host disease (GVHD) in comparison with HLA-identical sibling transplants. Using a limiting dilution analysis system for quantitating frequencies of alloreactive cytotoxic T lymphocyte precursors (CTL-p), we previously demonstrated a correlation between CTL-p frequency and HLA disparity between responder and stimulator, and between CTL-p frequency and the incidence of acute GVHD following HLA A, B, DR matched unrelated donor BMT. In this study we assayed CTL-p frequencies in two HLA 'matched' unrelated donor/patient pairs, with single HLA antigenic mismatches detected by allogenotyping or isoelectric focusing but not by HLA serology, and demonstrated that the CTL-ps were specifically directed at the mismatched antigen. Both class I and class II antigens were detected. These data, and our previous work, suggest that high CTL-p frequencies in HLA 'matched' unrelated pairs are indicative of HLA antigenic variants undetected by serology but recognized by molecular typing, and that these are responsible for the value of the assay in predicting acute GVHD after BMT. We propose that this assay system be used in aiding final donor selection before unrelated or mismatched related donor BMT.

Current orientation induced by magnetic stimulation influences a cognitive task.

The direction of the current induced by transcranial magnetic stimulation (TMS) over the motor cortex has been observed to influence the threshold and latency of evoked muscle responses. This study investigates the effect of TMS-induced current orientation (ICO) over the prefrontal cortex, on a specific cognitive task (memory-guided saccade). TMS was applied with a figure-of-eight coil, placed at one of eight different orientations over the prefrontal cortex. The most effective ICO was antero-lateral, which is a different optimal ICO from that seen over the hand area of the motor cortex. This demonstrates that ICO can alter the effect of TMS on cognitive functions and that ICO is an independent variable that should not be ignored when designing TMS studies.

Statistical limits for detecting change in the cumulative sum derivative of the peristimulus time histogram.

The peristimulus time histogram (psth) provides a means of correlating the discharges of neurones with other events. The cumulative sum (cusum) derived from the psth facilitates the detection of small changes in the psth that may be obscured by random fluctuations in counts. The cusum integrates differences from the mean control level of counts in the psth. Any signal in the data that is related to the stimulus appears as a slope in the cusum. Psth's constructed from the rhythmic discharges of single neurones are shown to contain periodical fluctuations in counts that arise from refractoriness. This periodicity results in a cusum which deviates less from the horizontal line than predicted from a Poisson distribution of points. The more regular the spike train, i.e., the lower the coefficient of variation of the distribution of interspike intervals, the flatter is the cusum. The theory of stochastic point processes is used to derive an algorithm for calculating the best approximation of variance of the cusum. Significance limits set at 3 standard deviations of the cusum are shown to provide a good fit to cusums for unit discharges over a wide range of coefficients of variation (0.09-0.60).

Voluntary motor function in patients with chronic fatigue syndrome.

INTRODUCTION: The pathogenesis of chronic fatigue syndrome (CFS) remains unknown. In particular, little is known of the involvement of the motor cortex and corticospinal system. METHODS: Transcranial magnetic stimulation (TMS) was used to assess corticospinal function in terms of latency and threshold of motor-evoked potentials (MEPs) in thenar muscles. Reaction times and speed of movement were assessed using button presses in response to auditory tones. RESULTS: Patients had higher (P<.05) self-assessed indices of fatigue (7/10) than for pain (5/10), anxiety (4/10) or depression (3/10). Mean (+/-S.E.M.) simple reaction times (SRTs) were longer (P<.05) in the patients (275+/-19 ms) than in the controls (219+/-9 ms); choice reaction times (CRTs) were not significantly longer in the patients. Movement times, once a reaction task had been initiated, were longer (P<.05) in the patients in both SRTs (patients, 248+/-13 ms; controls, 174+/-9 ms) and CRTs (patients, 269+/-13 ms; controls, 206+/-12 ms). There was no difference (P>.05) in threshold or latency of MEPs in hand muscles between the patients (threshold, 54.5+/-2.2% maximum stimulator output [% MSO]; latency 22+/-0.3 ms) and controls (threshold 54.6+/-3.6% MSO; latency 22.9+/-0.5 ms). Regression analysis showed no correlation (P>.05) of SRTs with either threshold for MEPs or fatigue index. CONCLUSION: Corticospinal conduction times and excitability were within the normal range despite a slower performance time for motor tasks and an increased feeling of fatigue. This suggests that the feeling of fatigue and the slowness of movement seen in CFS are manifest outside the corticospinal system.

Perceptual threshold to cutaneous electrical stimulation in patients with spinal cord injury.

STUDY DESIGN: Prospective experimental. OBJECTIVES: The aim of this study was to develop a quantitative sensory test (QST) that could be used for assessing the level and the density (degree of impairment) of spinal cord injury (SCI) and for monitoring neurological changes in patients with SCI. SETTING: National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, UK. METHODS: Perceptual threshold to 3 Hz cutaneous electrical stimulation was measured in 30 control subjects and in 45 patients with SCI at American Spinal Injuries Association (ASIA) sensory key points for selected dermatomes between C3 and S2 bilaterally. Electrical perceptual threshold (EPT) was recorded as the lowest ascending stimulus intensity out of three tests at which the subject reported sensation. The level of SCI according to EPT results was established for right and left sides as the most caudal spinal segment at which patient's EPT was within the control range (mean +/- 2 standard deviation (SD)). The level of SCI, according to EPT, was then compared with clinical sensory level derived according to ASIA classification. RESULTS: In the control group, EPT depended on the dermatome tested and was lowest for T1 (1.01 +/- 0.23 mA, mean +/- SD) and highest for L5 (3.32 +/- 1.14 mA). There was strong correlation between corresponding right and left dermatomes and between repeated assessments. In the SCI group, the level of lesion according to EPT and clinical testing was the same in 43 of the 90 tests (48%). In 37 cases (41%), the EPT level was higher than the clinical level, and in 10 cases (11%), it was lower. Below the level of lesion in incomplete SCI and in the zone of partial preservation in complete SCI, the EPT values in most dermatomes were raised compared with the control group. CONCLUSIONS: EPT is a simple, reproducible QST that can assess both the level and the density of SCI. It seems to add sensitivity and resolution to the standard clinical testing and could be a useful adjunct in longitudinal monitoring of patients with SCI for research purposes during natural recovery and therapeutic interventions. SPONSORSHIP: International Spinal Research Trust (ISRT), UK, Grant CLI001.

Motor neurone excitability in back muscles assessed using mechanically evoked reflexes in spinal cord injured patients.

OBJECTIVE: The clinical and functional assessment of back muscles in human spinal cord injury (SCI) has received little attention. The aim of this study was to develop a method to assess the level of a thoracic spinal cord lesion based on the reflex activation of back muscles. METHODS: In 11 control subjects and in 12 subjects with clinically complete thoracic SCI (T2-T12), either a spinous process or an erector spinae muscle was prodded to elicit short latency reflexes recorded electromyographically at the spinal level of stimulation. An electromagnetic servo, attached to a blunt probe, applied stimuli at a frequency of 1 Hz and amplitude of 3 mm. Two trials of 50 mechanical prods were conducted at each site. RESULTS: Reflexes were evoked in control subjects in 82% of trials when the spinous process was prodded, and in 80% of trials when the muscle was prodded. In contrast, reflexes in SCI subjects could be elicited in 90-100% of trials two segments either above or below the lesion. Reflex responses in control subjects had a mean (SEM) latency of 5.72 (0.53) ms when the spinous process was prodded, and 5.42 (0.42) ms when the muscle was prodded. In the SCI subjects, responses had slightly (but insignificantly) longer latencies both above and below the lesion to either stimulus. The amplitude of reflex responses, expressed as a percentage of the background EMG, was on average 2-3 times larger at the three vertebral levels spanning the lesion in SCI subjects than at sites above or below the lesion or at any level in control subjects. CONCLUSION: We propose that the size of these mechanically evoked reflexes may be useful in determining the level of thoracic SCI. Furthermore, the reflexes might provide a valuable tool with which to monitor recovery after an intervention to repair or improve function of a damaged spinal cord.

Control from the brainstem of synchrony of discharge between gamma motoneurones in the cat.

An assessment has been made of the effect of partial and complete section of the spinal cord on the discharges of gamma motoneurones to hind limb muscles in the decerebrated cat. The degree to which the discharges of pairs of individual gamma motoneurones exhibit short-term synchrony and the variability in interspike intervals of the discharge in individual neurones was measured. Variability of discharge was assessed as coefficient of variation of interspike intervals and degree of synchronization assessed from cross correlation analysis. The discharges of gamma motoneurones in the decerebrated cat with intact spinal cord are regular (low coefficient of variation) and show no tendency to synchrony for up to 24 h following decerebration. Section of the more medial part of the dorsolateral funiculus, on either side of the thoracic spinal cord, resulted in a less regular discharge and the development of short-term synchrony between gamma motoneurones. A dependence of synchrony on variability of discharge was established. The synchrony and increased variability in the spinal cat persisted for at least 24 h. Both were markedly reduced following administration of the precursors of monoamines (either L-Dopa or 5-HTP). We conclude that a bilateral, monoaminergic pathway descending in the dorsolateral funiculus from the brainstem controls synchrony of gamma motoneurone discharge in the decerebrated cat. The possibility is discussed that synchrony of discharge between alpha motoneurones may be controlled by a similar pathway.

Facilitation of individual gamma-motoneurones by the discharge of single slowly adapting type 1 mechanoreceptors in cats.

1. Cross-correlation of the discharges of individual neurones has been used to investigate the influence of identified cutaneous afferents on gamma-motoneurones below the level of complete spinal section in decerebrated cats. Discharges of single, sural nerve afferents from the heel were recorded in the dorsal root ganglia. Discharges of gamma-motoneurones were recorded from cut filaments of the muscle nerve to gastrocnemius medialis of the same leg. gamma-Motoneurones had a background discharge in the absence of intentional stimulation. 2. Correlograms involving slowly adapting afferents were formed during steady application of a probe to the receptive field for repeated periods of 10 s. Afferent synchronization was minimized by rejecting any period of probe movement. Correlograms involving rapidly adapting afferents required continuous movement of the probe to sustain afferent discharge. 3. Statistically significant primary peaks in correlations were observed for twenty-one pairings of gamma-motoneurones with seventeen out of thirty-nine slowly adapting, type 1 (SA1) mechanoreceptors. Primary peaks had widths at half-maximum in the range of 2-7 ms. No such short duration peaks were seen for fourteen pairings of gamma-motoneurones with eleven slowly adapting type 2 (SA2) receptors or for thirty-five pairings with twenty-nine hair follicle (HF) afferents. Broad correlations with peaks extending over tens of milliseconds were seen for HF afferents and could be generated in correlograms for slowly adapting afferents by moving the probe. 4. The short duration peaks were delayed with respect to the SA1 afferent discharges. Subtraction of peripheral conduction times gave central delays for the increased probability of gamma-motoneurone firing ranging from 2.7 to 6.5 ms (mean = 4.0 ms). These values were not significantly different from the central delays of gamma-motoneurone excitation in response to electrical stimulation of the sural nerve at a strength 1.2 times threshold. 5. The increase in probability of gamma-motoneurone discharge given a single SA1 afferent discharge ranged from 0.005 to 0.156 with a mean value of 0.052. The rise time of the peak ranged from 1 to 4 ms with a mean value of 1.9 ms (n = 9). 6. The properties of the correlogram peaks were not related to the axon conduction velocity of either the SA1 afferent or gamma efferent neurones. 7. The SA1 afferents that facilitated gamma-motoneurone discharge had axon conduction velocities in the range 29-81 m/s and could not be distinguished from SA1 afferents lacking correlations.(ABSTRACT TRUNCATED AT 400 WORDS)

Excitability of the motor cortex in schizophrenia following typical and atypical antipsychotics: two serial case reports.

A previous electrophysiological investigation of schizophrenia using transcranial magnetic stimulation has shown altered corticospinal inhibition in medicated patients compared with drug-naive patients. Based on this work, we have carried out the first serial electrophysiological case studies of the human corticospinal system in schizophrenia in which a typical antipsychotic was compared with an atypical antipsychotic. We used transcranial magnetic stimulation-based techniques to study the time course of drug action in two antipsychotic drug-naive patients with schizophrenia; one patient treated with a typical antipsychotic (haloperidol) and the other with an atypical antipsychotic (risperidone). The typical antipsychotic was associated with an increase in corticospinal excitability which we found to occur 4-5 weeks after beginning medication. In contrast, the atypical antipsychotic was associated with a decrease in corticospinal excitability, occurring 3-4 weeks after starting pharmacotherapy. We conclude that these opposite neurophysiological effects are related to the relative dopaminergic and serotonergic actions of the two classes of drug.

The degree of short-term synchrony between alpha- and gamma-motoneurones coactivated during the flexion reflex in the cat.

Cross-correlation analysis of unitary neuronal discharges has been used to study the linkage between alpha- and gamma-motoneurones coactivated during the flexion reflex of the semitendinosus muscle in the decerebrated spinal cat. A flexion reflex was elicited by firm grip or squeeze of the ipsilateral heel, shank or foot. The stimulus excited the discharges of both alpha- and gamma-motoneurones and increased the frequency of discharge of those gamma-motoneurones that had shown a background discharge prior to intentional stimulation. Short-term synchrony was present between a high proportion of semitendinosus gamma-motoneurones both for background discharges (sixteen out of nineteen pairs) and during the flexion reflex (thirteen out of fifteen pairs). All nineteen pairs of alpha-motoneurones examined during the flexion reflex showed short-term synchrony of discharge. Few alpha-motoneurones displayed background discharges but synchrony was observed in the two instances studied. The degree of synchrony was measured as the ratio (kappa) of the total counts contributing to the peak of the correlogram over the number expected by chance alone. The ratio was higher when the average frequency of motoneurone discharge was low. Kappa was generally higher for alpha-motoneurone pairs than for gamma-motoneurone pairs. The higher degree of synchrony for alpha-motoneurones reflected their lower discharge rates. During the flexion reflex the degree of synchrony between gamma-motoneurones was greater than expected for that same discharge rate in the absence of intentional stimulation. Only twenty-seven out of forty pairings of an alpha- with a gamma-motoneurone showed a significant degree of synchrony of discharge. On average, the degree of synchrony for alpha/gamma pairs was lower than that for either alpha/alpha or gamma/gamma pairings at the equivalent discharge rate. The results support the conclusion that coactivation of alpha- and gamma-motoneurones during the flexion reflex occurs largely through independent sets of interneurones. The possibility is discussed that those alpha-motoneurones which showed short-term synchrony with gamma-motoneurones were skeleto-fusimotor (beta-motoneurones) in nature.

Organization of the sural cutaneous input regulating the discharge of triceps surae gamma-motoneurones in the cat.

The organization of the cutaneous afferent influence on the discharge of gamma-motoneurones has been investigated in the decerebrated, spinal cat. gamma-Motoneurone discharges were recorded from cut nerve filaments. Time and frequency domain analyses were used to reveal the strength of coupling between gamma-motoneurone discharge and cutaneous afferents excited by natural skin stimulation. Time domain analysis (cross-correlation) was also used to reveal the sigh (facilitation or inhibition) and time course of the cutaneous influence on individual gamma-motoneurones. Mechanical stimulation of discrete areas of skin within the sural nerve field caused facilitation or inhibition of individual gamma-motoneurones supplying the gastrocnemius and soleus muscles. In a few cases, a gamma-motoneurone facilitated by stimulation at one site could be inhibited from another location. The effect of cutaneous afferent stimulation was not evident in the decerebrated cat with intact spinal cord. The intensity of facilitation and inhibition was mapped for the sural nerve field. Facilitation had focus of highest intensity to stimulation applied between the calcaneum and lateral malleolus. The focus for inhibition was either the same as for facilitation or, more frequently, tended to be lateral and dorsal to the calcaneum at the edge of the sural field. Cutaneous stimulation at the edge of the sural field could also reduce the coherence between the discharges of gamma-motoneurones, particularly at low frequencies of association (1-5 Hz), indicating disfacilitation of other sources of afferent input. The results reveal a detailed pattern of cutaneous inputs to the fusimotor system that could participate in a wide range of behavioural adjustments to stretch or contact of the skin at the heel.

Facilitation of human first dorsal interosseous muscle responses to transcranial magnetic stimulation during voluntary contraction of the contralateral homonymous muscle.

The size of compound motor evoked potentials (cMEPs) to transcranial magnetic stimulation of the motor cortex was measured in the relaxed first dorsal interosseous muscle of the nondominant hand (ndFDI) during different levels of voluntary contraction in the homonymous muscle of the dominant hand (dFDI). cMEP responses in the ndFDI became larger when the dFDI was contracted to forces ranging 10-70% of maximum voluntary contraction. Variability in the amplitude of the cMEP responses in ndFDI decreased when dFDI was contracted. Comparison with cMEPs to spinal cord stimulation suggested a large component of the facilitation was occurring at a cortical level. The amplitude of cMEP responses in ndFDI also increased when the tibialis anterior muscle of the leg on the contralateral side was contracted. The observed facilitation of motoneurons during contraction of contralateral muscles might involve a transcallosal pathway modulating the excitability of one cortex when the other is activated.

Somatopy of perceptual threshold to cutaneous electrical stimulation in man.

Neurological testing tools for measuring and monitoring somatosensory function lack resolution and are often dependent on the clinician testing. In this study we have measured perceptual threshold (PT) to electrical stimulation of the skin and compared it with two-point discriminative ability (TPDA) in 12 control subjects. Tests were made on both sides of the body at American Spinal Injury Association (ASIA) key points on seven spinal dermatomes (C3 (neck), C4 (shoulder), C5 (upper arm), C6 (thumb), T8 (abdomen), L3 (knee), L5 (foot)) and in the mandibular (chin) and maxillary (cheek) fields of the trigeminal (V) nerve. Electrical stimulation (0.5 ms pulse width; 3 Hz) was applied via a self-adhesive cathode and an anode strapped to the wrist or ankle. The stimulus intensity was adjusted and PT was recorded as the lowest current at which the subject reported sensation. Sites were tested in random order. Indices for both TPDA and PT differed according to the dermatome tested but there was no correlation between TPDA and PT for any dermatome. There was good correlation between results from equivalent dermatomes on left and right sides for both PT and TPDA. Women frequently had lower mean (+/- S.E.) PTs and better TPDA than men; differences were significant (P < 0.05) for PT on the knee (women, 1.31 +/- 0.15 mA; men, 2.05 +/- 0.26 mA) and the foot (women, 2.90 +/- 0.19 mA; men, 4.13 +/- 0.28 mA) and for TPDA on the thumb (women, 3.8 +/- 0.2 mm; men, 7.8 +/- 1.3 mm) and the knee (women, 17.8 +/- 1.6 mm; men, 27.1 +/- 4.0 mm). Four subjects repeated the experiment on another day and the results correlated well with the first test for PT (r2, 0.62) and TPDA (r2, 0.48). PT differs between dermatomes in a predictable way but does not relate to TPDA. PT is easy to measure and may be a useful assessment tool with which to monitor recovery or deterioration in neuropathies, neurotrauma or after surgery.

Corticospinal control of human erector spinae muscles.

We used transcranial magnetic stimulation (TMS) to study corticospinal excitability to erector spinae (ES) muscles during graded voluntary contractions in bilateral trunk extension (BTE) and forced expiratory breath holding (FEBH) in normal individuals. Motor evoked potentials (MEPs) could be produced in all subjects in the absence of voluntary activation. At maximum voluntary contraction, levels of surface electromyographic (EMG) activity were 4 times greater during BTE than FEBH. When EMG was normalized to maximum, MEP amplitudes increased in proportion to contraction in both tasks. MEPs in FEBH were compared with extrapolated values at similar EMG levels in BTE and were found to be larger. EMG and MEPs in left and right ES were symmetrical throughout the range of contractions in both tasks. ES muscles have a facilitation pattern similar to that previously shown in leg muscles, but subtle differences at low levels of EMG suggest that the facilitation is dependent on the task.