Contralateral Movements Research Articles

Kernels of Motor Memory Formation: Temporal Generalization in Bimanual Adaptation.

In daily life, we coordinate both simultaneous and sequential bimanual movements to manipulate objects. Our ability to rapidly account for different object dynamics suggests there are neural mechanisms to quickly deal with them. Here we investigate how actions of one arm can serve as a contextual cue for the other arm, and facilitate adaptation. Specifically, we examine the temporal characteristics that underlie motor memory formation and recall, by testing the contextual effects of prior, simultaneous, and post contralateral arm movements in both male and female human participants. To do so, we measure their temporal generalization in three bimanual interference tasks. Importantly, the timing context of the learned action plays a pivotal role in the temporal generalization. While motor memories trained with post adaptation contextual movements generalize broadly, motor memories trained with prior contextual movements exhibit limited generalization, and motor memories trained with simultaneous contextual movements do not generalize to prior or post contextual timings. This highlights temporal tuning in sensorimotor plasticity: different training conditions yield substantially different temporal generalization characteristics. Since these generalizations extend far beyond any variability in training times, we suggest that the observed differences may stem from inherent differences in the use of prior, current and post-adaptation contextual information in the generation of natural behavior. This would imply differences in the underlying neural circuitry involved in learning and executing the corresponding coordinated bimanual movements.Significance Statement This study addresses a fundamental question in the field of sensorimotor neuroscience of how multiple movements are temporally linked within a single motor memory. We examine the temporal generalization of motor memory formation by varying the timing of contextual movements associated with a learned motor memory across a range of prior, current, and post adaptation movement times using a bimanual motor learning task. We observed distinct patterns of temporal generalization based on whether the contextual movements occurred prior to, simultaneously with, or after the adaptation movement. For the first time, our findings reveal that the timing of contextual movements is crucial in the formation and generalization of motor memories.

Tool-sensed object information effectively supports vision for multisensory grasping.

Tools enable humans to extend their sensing abilities beyond the natural limits of their hands, allowing them to sense objects as if they were using their hands directly. The similarities between direct hand interactions with objects (hand-based sensing) and the ability to extend sensory information processing beyond the hand (tool-mediated sensing) entail the existence of comparable processes for integrating tool- and hand-sensed information with vision, raising the question of whether tools support vision in bimanual object manipulations. Here, we investigated participants' performance while grasping objects either held with a tool or with their hand and compared these conditions with visually guided grasping (Experiment 1). By measuring reaction time, peak velocity, and peak of grip aperture, we found that actions were initiated earlier and performed with a smaller peak grip aperture when the object was seen and held with the tool or the contralateral hand compared to when it was only seen. Thus, tool-mediated sensing effectively supports vision in multisensory grasping and, even more intriguingly, resembles hand-based sensing. We excluded that results were due to the force exerted on the tool's handle (Experiment 2). Additionally, as for hand-based sensing, we found evidence that the tool supports vision by mainly providing object positional information (Experiment 3). Thus, integrating the tool-sensed position of the object with vision is sufficient to promote a multisensory advantage in grasping. Our findings indicate that multisensory integration mechanisms significantly improve grasping actions and fine-tune contralateral hand movements even when object information is only indirectly sensed through a tool. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interactive Virtual Ankle Movement Controlled by Wrist sEMG Improves Motor Imagery: An Exploratory Study.

Virtual reality (VR) techniques can significantly enhance motor imagery training by creating a strong illusion of action for central sensory stimulation. In this article, we establish a precedent by using surface electromyography (sEMG) of contralateral wrist movement to trigger virtual ankle movement through an improved data-driven approach with a continuous sEMG signal for fast and accurate intention recognition. Our developed VR interactive system can provide feedback training for stroke patients in the early stages, even if there is no active ankle movement. Our objectives are to evaluate: 1) the effects of VR immersion mode on body illusion, kinesthetic illusion, and motor imagery performance in stroke patients; 2) the effects of motivation and attention when utilizing wrist sEMG as a trigger signal for virtual ankle motion; 3) the acute effects on motor function in stroke patients. Through a series of well-designed experiments, we have found that, compared to the 2D condition, VR significantly increases the degree of kinesthetic illusion and body ownership of the patients, and improves their motor imagery performance and motor memory. When compared to conditions without feedback, using contralateral wrist sEMG signals as trigger signals for virtual ankle movement enhances patients' sustained attention and motivation during repetitive tasks. Furthermore, the combination of VR and feedback has an acute impact on motor function. Our exploratory study suggests that the sEMG-based immersive virtual interactive feedback provides an effective option for active rehabilitation training for severe hemiplegia patients in the early stages, with great potential for clinical application.

Functional ultrasound neuroimaging reveals mesoscopic organization of saccades in the lateral intraparietal area of posterior parietal cortex.

The lateral intraparietal cortex (LIP) located within the posterior parietal cortex (PPC) is an important area for the transformation of spatial information into accurate saccadic eye movements. Despite extensive research, we do not fully understand the functional anatomy of intended movement directions within LIP. This is in part due to technical challenges. Electrophysiology recordings can only record from small regions of the PPC, while fMRI and other whole-brain techniques lack sufficient spatiotemporal resolution. Here, we use functional ultrasound imaging (fUSI), an emerging technique with high sensitivity, large spatial coverage, and good spatial resolution, to determine how movement direction is encoded across PPC. We used fUSI to record local changes in cerebral blood volume in PPC as two monkeys performed memory-guided saccades to targets throughout their visual field. We then analyzed the distribution of preferred directional response fields within each coronal plane of PPC. Many subregions within LIP demonstrated strong directional tuning that was consistent across several months to years. These mesoscopic maps revealed a highly heterogenous organization within LIP with many small patches of neighboring cortex encoding different directions. LIP had a rough topography where anterior LIP represented more contralateral upward movements and posterior LIP represented more contralateral downward movements. These results address two fundamental gaps in our understanding of LIP's functional organization: the neighborhood organization of patches and the broader organization across LIP. These findings were achieved by tracking the same LIP populations across many months to years and developing mesoscopic maps of direction specificity previously unattainable with fMRI or electrophysiology methods.

Differential Modulation of Local Field Potentials in the Primary and Premotor Cortices during Ipsilateral and Contralateral Reach to Grasp in Macaque Monkeys.

Hand movements are associated with modulations of neuronal activity across several interconnected cortical areas, including the primary motor cortex (M1) and the dorsal and ventral premotor cortices (PMd and PMv). Local field potentials (LFPs) provide a link between neuronal discharges and synaptic inputs. Our current understanding of how LFPs vary in M1, PMd, and PMv during contralateral and ipsilateral movements is incomplete. To help reveal unique features in the pattern of modulations, we simultaneously recorded LFPs in these areas in two macaque monkeys performing reach and grasp movements with either the right or left hand. The greatest effector-dependent differences were seen in M1, at low (≤13 Hz) and γ frequencies. In premotor areas, differences related to hand use were only present in low frequencies. PMv exhibited the greatest increase in low frequencies during instruction cues and the smallest effector-dependent modulation during movement execution. In PMd, δ oscillations were greater during contralateral reach and grasp, and β activity increased during contralateral grasp. In contrast, β oscillations decreased in M1 and PMv. These results suggest that while M1 primarily exhibits effector-specific LFP activity, premotor areas compute more effector-independent aspects of the task requirements, particularly during movement preparation for PMv and production for PMd. The generation of precise hand movements likely relies on the combination of complementary information contained in the unique pattern of neural modulations contained in each cortical area. Accordingly, integrating LFPs from premotor areas and M1 could enhance the performance and robustness of brain-machine interfaces.

A case of diabetic striatopathy due to uncontrolled type 2 diabetes.

Hemichorea-hemiballismus (HCHB) syndrome is a syndrome characterized by choreic movements which are irregular, nonrepetitive, and random movements, and ballismus which are spontaneous and violent movements. HCHB syndrome with a metabolic cause is a rare presentation that can be precipitated by uncontrolled diabetes. Presented here is a case of HCHB syndrome with right-sided neuroimaging findings and contralateral chorea due to uncontrolled type 2 diabetes mellitus. This patient was found to be obtunded with a blood glucose of greater than 500 mg/dL by EMS. After the administration of insulin, she was able to answer clarifying questions of noncompliance with her antihyperglycemic medications. She had a computed tomography without contrast of the head which showed hyperdense lesions in the right caudate nucleus and putamen consistent with HCHB syndrome. She was started on treatment for nonketotic hyperglycemia with insulin. As her mentation improved, she was able to cooperate with physical examination, which revealed irregular and violent movements in the left upper and lower extremities. Her hemichorea and hemiballismus improved with strict glycemic control, and she was able to be discharged to a skilled nursing facility for further rehabilitation. She would later have repeated hospitalizations for poor glycemic control, and repeat neuroimaging would reveal the resolution of hyperdensities after 4 months. HCHB syndrome due to uncontrolled diabetes has been termed diabetic striatopathy and is characterized by poor glycemic control, unilateral striatal hyperdensity on CT imaging, and contralateral choreic movements. Diabetic striatopathy remains a poorly understood disease, and the exact pathophysiologic mechanism has not been definitively elucidated. Diabetic striatopathy is a relatively new term for metabolic etiology of hemichorea-hemiballismus syndrome and was coined in 2009. The triad for diabetic striatopathy is poor glycemic control, unilateral striatal hyperdensity on CT imaging, and contralateral choreic movements. Multiple etiologies have been suggested for the cause of diabetic striatopathy including petechial hemorrhage, mineral deposition, myelin destruction, and infarction with reactive astrocytosis; however, the exact mechanism has yet to be determined. Antidopaminergic medications may be used to control the choreic movements of diabetic striatopathy; however, the mainstay of treatment is glycemic control, often with insulin therapy.

489 Increase in Broadband Power Is an Electrophysiologic Marker of Focal Thalamic Activity During Movement

INTRODUCTION: The architecture of the human thalamus is currently indirectly inferred from human histopathologic and non-human animal studies. Given that movement-related increases in broadband power from electrocorticography recording have been previously shown to identify specific motor cortical subregions involved with a particular movement, we explored whether this phenomenon can also be used to localize motor subregions of thalamus. METHODS: We performed serial human thalamic local field potentials recordings using an electrode moved through the lateral thalamusduring deep brain stimulation surgery in 10 subjects. During the recording at each location, subjects alternated between 5 second epochs of rest and 5 second periods of contralateral hand movement. Power spectra were generated for each epoch using Welch’s overlapping periodogram method (1 second window, 50% overlap). Spectra from all movement and rest epochs were separately averaged. The difference between the power in the 65 to 95 Hz band during movement versus rest was used as a proxy for task-related change in broadband activity. Task-related differences in prominent low-frequency oscillations (patient-specific sub-ranges within 5 to 30 Hz) were analyzed per individual oscillation and in aggregate. Significance was determined using unpaired T tests at a threshold of p = 0.05. RESULTS: We find that recording sites showing statistically significant increases in broadband power during movement tend to tightly cluster in areas predicted to represent motor thalamus, whereas sites showing statistically significant reduction in the power (desynchronization) of low frequency oscillations are more diffusely distributed. This finding is replicated across all subjects. CONCLUSIONS: These results suggest that a task-dependent increase in broadband power is an electrophysiologic marker of focal thalamic activity and may be useful to delineate specific thalamic subregions on an individual subject basis.

Physiological effects of dual target DBS in an individual with Parkinson's disease and a sensing-enabled pulse generator

IntroductionDeep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus (GP) is an established therapy for Parkinson's disease (PD). Novel DBS devices can record local field potential (LFP) physiomarkers from the STN or GP. While beta (13–30 Hz) and gamma (40–90 Hz) STN and GP LFP oscillations correlate with PD motor severity and with therapeutic effects of treatments, STN-GP interactions in electrophysiology in patients with PD are not well characterized. MethodsSimultaneous bilateral STN and GP LFPs were recorded in a patient with PD who received bilateral STN-DBS and GP-DBS. Power spectra in each target and STN-GP coherence were assessed in various ON- and OFF-levodopa and DBS states, both at rest and with voluntary movement. ResultsOFF-levodopa and OFF-DBS, beta peaks were present at bilateral STN and GP, coincident with prominent STN-GP beta coherence. Levodopa and dual-target-DBS (simultaneous STN-DBS and GP-DBS) completely suppressed STN-GP coherence. Finely-tuned gamma (FTG) activity at half the stimulation frequency (62.5 Hz) was seen in the STN during GP-DBS at rest. To assess the effects of movement on FTG activity, we recorded LFPs during instructed movement. We observed FTG activity in bilateral GP and bilateral STN during contralateral body movements while on GP-DBS and ON-levodopa. No FTG was seen with STN-DBS or dual-target-DBS. ConclusionDual-target-DBS and levodopa suppressed STN-GP coherence. FTG throughout the basal ganglia was induced by GP-DBS in the presence of levodopa and movement. This bilateral STN-FTG and GP-FTG corresponded with the least severe bradykinesia state, suggesting a pro-kinetic role for FTG.

Dopamine neuron activity encodes the length of upcoming contralateral movement sequences

Dopaminergic neurons (DANs) in the substantia nigra pars compacta (SNc) have been related to movement speed, and loss of these neurons leads to bradykinesia in Parkinson's disease (PD). However, other aspects of movement vigor are also affected in PD; for example, movement sequences are typically shorter. However, the relationship between the activity of DANs and the length of movement sequences is unknown. We imaged activity of SNc DANs in mice trained in a freely moving operant task, which relies on individual forelimb sequences. We uncovered a similar proportion of SNc DANs increasing their activity before either ipsilateral or contralateral sequences. However, the magnitude of this activity was higher for contralateral actions and was related to contralateral but not ipsilateral sequence length. In contrast, the activity of reward-modulated DANs, largely distinct from those modulated by movement, was not lateralized. Finally, unilateral dopamine depletion impaired contralateral, but not ipsilateral, sequence length. These results indicate that movement-initiation DANs encode more than a general motivation signal and invigorate aspects of contralateral movements.

Contrasting MEG effects of anodal and cathodal high-definition TDCS on sensorimotor activity during voluntary finger movements.

Protocols for noninvasive brain stimulation (NIBS) are generally categorized as "excitatory" or "inhibitory" based on their ability to produce short-term modulation of motor-evoked potentials (MEPs) in peripheral muscles, when applied to motor cortex. Anodal and cathodal stimulation are widely considered excitatory and inhibitory, respectively, on this basis. However, it is poorly understood whether such polarity-dependent changes apply for neural signals generated during task performance, at rest, or in response to sensory stimulation. To characterize such changes, we measured spontaneous and movement-related neural activity with magnetoencephalography (MEG) before and after high-definition transcranial direct-current stimulation (HD-TDCS) of the left motor cortex (M1), while participants performed simple finger movements with the left and right hands. Anodal HD-TDCS (excitatory) decreased the movement-related cortical fields (MRCF) localized to left M1 during contralateral right finger movements while cathodal HD-TDCS (inhibitory), increased them. In contrast, oscillatory signatures of voluntary motor output were not differentially affected by the two stimulation protocols, and tended to decrease in magnitude over the course of the experiment regardless. Spontaneous resting state oscillations were not affected either. MRCFs are thought to reflect reafferent proprioceptive input to motor cortex following movements. Thus, these results suggest that processing of incoming sensory information may be affected by TDCS in a polarity-dependent manner that is opposite that seen for MEPs-increases in cortical excitability as defined by MEPs may correspond to reduced responses to afferent input, and vice-versa.

Differential contribution of sensorimotor cortex and subthalamic nucleus to unimanual and bimanual hand movements.

Why does unilateral deep brain stimulation improve motor function bilaterally? To address this clinical observation, we collected parallel neural recordings from sensorimotor cortex (SMC) and the subthalamic nucleus (STN) during repetitive ipsilateral, contralateral, and bilateral hand movements in patients with Parkinson's disease. We used a cross-validated electrode-wise encoding model to map electromyography data to the neural signals. Electrodes in the STN encoded movement at a comparable level for both hands, whereas SMC electrodes displayed a strong contralateral bias. To examine representational overlap across the two hands, we trained the model with data from one condition (contralateral hand) and used the trained weights to predict neural activity for movements produced with the other hand (ipsilateral hand). Overall, between-hand generalization was poor, and this limitation was evident in both regions. A similar method was used to probe representational overlap across different task contexts (unimanual vs. bimanual). Task context was more important for the STN compared to the SMC indicating that neural activity in the STN showed greater divergence between the unimanual and bimanual conditions. These results indicate that SMC activity is strongly lateralized and relatively context-free, whereas the STN integrates contextual information with the ongoing behavior.

Evidence and Mechanisms for Embolic Stroke in Contralateral Hemispheres From Carotid Artery Sources.

Disambiguation of embolus pathogenesis in embolic strokes is often a clinical challenge. One common source of embolic stroke is the carotid arteries, with emboli originating due to plaque buildup or perioperatively during revascularization procedures. Although it is commonly thought that thromboemboli from carotid sources travel to cerebral arteries ipsilaterally, there are existing reports of contralateral embolic events that complicate embolus source destination relationship for carotid sources. Here, we hypothesize that emboli from carotid sources can travel to contralateral hemispheres and that embolus interactions with collateral hemodynamics in the circle of Willis influence this process. We use a patient-specific computational embolus-hemodynamics interaction model developed in prior works to conduct an in silico experiment spanning 4 patient vascular models, 6 circle of Willis anastomosis variants, and 3 different thromboembolus sizes released from left and right carotid artery sites. This led to a total of 144 different experiments, estimating trajectories and distribution of approximately 1.728 million embolus samples. Across all cases considered, emboli from left and right carotid sources showed nonzero contralateral transport (P value <-0.05). Contralateral movement revealed a size dependence, with smaller emboli traveling more contralaterally. Detailed analysis of embolus dynamics revealed that collateral flow routes in the circle of Willis played a role in routing emboli, and transhemispheric movement occurred through the anterior and posterior communicating arteries in the circle of Willis. We generated quantitative data demonstrating the complex dynamics of finite size thromboembolus particles as they interact with pulsatile arterial hemodynamics and traverse the vascular network of the circle of Willis. This leads to a nonintuitive source-destination relationship for emboli originating from carotid artery sites, and emboli from carotid sources can potentially travel to cerebral arteries on contralateral hemispheres.

Sleep and perivascular disruption: An illustrative case of severe sleep apnea, an enlarged Virchow-Robin space, and contralateral asymmetric periodic limb movements

Virchow-Robin spaces (VRS) are perivascular spaces that have been associated with impaired glymphatic function, poor sleep quality and sleep disorders. These spaces are also associated with neurological impairment. We report a case of a young adult male who presented with severe untreated sleep apnea, shift-work disorder, and excessive asymmetric periodic limb movements disorder in association with a prominent radiologically-identified VRS in the contralateral basal ganglia. This case illustrates the complex “chicken and egg” association between impaired sleep, the development of VRS, and subsequent sleep disorder most likely attributable to the development of this perivascular abnormality.

The Impact of Multiple Recesses on Limb Movement Patterns in Children: An Exploratory Study

Background: Inactivity levels among elementary-aged children are climbing at alarming rates, as only 24% participate in the recommended 60 minutes of daily physical activity. Limb movements during children’s active time are essential for heart, bone, and muscle health, setting the stage for an overall active and healthy life. School recess, defined as child-directed, outdoor play, is optimal for children to accumulate many types and repetitions of limb movements. Therefore, the purpose of this study was to use the Movement Pattern Observation Tool (MPOT) to determine the impact of varying amounts of daily recess on elementary-aged children’s limb movement patterns. It was hypothesized that children who participate in 60 minutes of daily recess would accumulate significantly more limb movements and specifically, contralateral movements as they advance in grades.&#x0D; Methods: This cross-sectional, observational study used the MPOT to observe grades K-2 children from two schools offering one twenty-minute recess daily and two schools offering four 15-minute recesses daily. The researchers observed 3,023 children’s limb movements during recess across the schools. There were 36 total observation scans completed for the four schools observed.&#x0D; Results: Children who received 60 minutes of recess maintained significantly higher activity levels and contralateral movements as they advanced by grade. Additionally, on average 96% of all children utilized unilateral, bilateral, or contralateral limb movements when observed.&#x0D; Conclusion: When given the opportunity, most children will utilize recess in a way that is beneficial for off-setting inactivity trends and is instrumental for a healthy mind-body connection as they age.

Puricelli biconvex arthroplasty: an experimental study in sheep

BackgroundThe aim of this study was to establish a sheep model of the Puricelli biconvex arthroplasty (ABiP) technique in sheep for evaluating its functional, biological and histological parameters.MethodsTen Corriedale black sheep were submitted to TMJ total reconstruction with poly(methyl methacrylate) (PMMA) using ABiP and euthanized after 45 (n = 5) or 90 (n = 5) days. Control animals (n = 2) underwent sham operations and were euthanized after 45 days. Variables were assessed before the surgery (T0), immediately after (T1) and at 45 or 90 postoperative days (T2).ResultsHistological analyses showed regression of inflammatory cells over the follow-up period. PMMA showed reduced porosity and roughness in the articular contact area. PMMA temporal components showed linear and volumetric wear in comparison to control, but no foreign body reaction was observed. The reconstructions were stable in all animals. The amplitude of mouth opening and left lateral movements were maintained, except for a reduction in the range of right lateral movements at day 90 in the experimental group. Clinical, macroscopic and radiographic observations showed that the reconstructions were stable.ConclusionsThe analysis of functional, biological and histological parameters in sheep submitted to ABiP showed stable results of the procedure, with maintenance of body weight and all mandibular movements, save contralateral mandibular movement, suggesting that joint function was completely maintained following the procedure. This experimental study provides support for clinical results previously reported of the ABiP technique in TMJ reconstruction procedures.

Decoding and geometry of ten finger movements in human posterior parietal cortex and motor cortex

Objective. Enable neural control of individual prosthetic fingers for participants with upper-limb paralysis. Approach. Two tetraplegic participants were each implanted with a 96-channel array in the left posterior parietal cortex (PPC). One of the participants was additionally implanted with a 96-channel array near the hand knob of the left motor cortex (MC). Across tens of sessions, we recorded neural activity while the participants attempted to move individual fingers of the right hand. Offline, we classified attempted finger movements from neural firing rates using linear discriminant analysis with cross-validation. The participants then used the neural classifier online to control individual fingers of a brain–machine interface (BMI). Finally, we characterized the neural representational geometry during individual finger movements of both hands. Main Results. The two participants achieved 86% and 92% online accuracy during BMI control of the contralateral fingers (chance = 17%). Offline, a linear decoder achieved ten-finger decoding accuracies of 70% and 66% using respective PPC recordings and 75% using MC recordings (chance = 10%). In MC and in one PPC array, a factorized code linked corresponding finger movements of the contralateral and ipsilateral hands. Significance. This is the first study to decode both contralateral and ipsilateral finger movements from PPC. Online BMI control of contralateral fingers exceeded that of previous finger BMIs. PPC and MC signals can be used to control individual prosthetic fingers, which may contribute to a hand restoration strategy for people with tetraplegia.

Development of the Movement Pattern Observation Tool (MPOT)—An Observational Tool to Measure Limb Movements during Elementary School Recess

The US Center for Disease Control estimates that only 24% of American elementary-aged children participate in the recommended 60 min of daily physical activity. As activity levels decline, elementary schools should consider increasing movement opportunities. Activity-driven school days, where children can move their limbs freely, may increase memory retention performance, behavioral impulse control, as well as bone density, and muscle strength. Unstructured, outdoor play (recess) may provide an opportunity for the brain, bone, and muscle-stimulating limb movements to be utilized. To date, no research has focused on whether the modern child actively uses limb movements during recess, nor to what degree. The purpose of this study was to develop a reliable assessment tool (Movement Pattern Observation Tool, MPOT) to observe and record limb movements (unilateral, bilateral, and contralateral movements) of elementary children during recess, defined in this study as unstructured, outdoor play. Three observers used the MPOT to complete thirty-five observations at one elementary school during kindergarten through fifth-grade recess breaks. Interrater reliability approached excellent, being that excellent is above 0.90. The ICC of the master observer and observer 3 value was 0.898 (95% CI 0.757-0.957), and the ICC of the master observer and observer 2 was 0.885 (95% CI 0.599-0.967), p < 0.03. Inter-rater reliability was achieved through a three-phase process. This reliable recess observation tool will contribute to the body of research linking recess to physical and cognitive health.

Ictal blinking triggered by isolated spikes as the only manifestation of seizures.

To describe blinking as the only manifestation of seizures from isolated focal and generalized cortical spikes and investigate the relationship between blinks and epileptic discharges. We measured the latency from the onset of spikes to the onset of blinks in two patients using electroencephalogram (EEG) and an electrooculogram (EOG), and calculated the median latency in both cases. We analyzed the latency from spike onset to the onset of additional specific eye movements, seen only in the second case. To determine the frequency of spontaneous blinks (not triggered by spikes), we defined a "control point" at 45 s following a random spike for the first case. We tested for statistically significant associations between latencies of blinks (Case 1) as well as between latencies of blinks and specific eye movements (Case 2). A total of 174 generalized spike-waves followed by a blink were analyzed in the first patient. Approximately 61% of the blinks occurred within 150-450 ms after the onset of the spike. Median latency for blinks following a spike was 294 ms compared to 541 ms for control blinks (p=.02). For the second patient, a total of 160 eye movements following a right occipito-parietal spike were analyzed. The median spike-blink latency in the second case was 497 milliseconds. Median latencies of spike onset to contralateral oblique eye movements with blink and left lateral eye movements were 648 and 655 milliseconds, respectively. Our study shows that isolated cortical spikes can induce epileptic seizures consisting exclusively of blinks. These findings emphasize the importance of careful EEG and EOG analysis to determine blinking as the only ictal phenomenon. We additionally describe a new technique to prove the temporal relationship between cortical discharges and a specific movement when, in addition to the movements triggered by a spike, the same movement is also spontaneously performed by the patient (in this case, blinking).

Secular trends in motor performance in Swiss children and adolescents from 1983 to 2018.

Environmental changes, including globalization, urbanization, social and cultural changes in society, and exposure to modern digital technology undoubtedly have an impact on children's activity and lifestyle behavior. In fact, marked reductions in children's physical activity levels have been reported over the years and sedentary behavior has increased around the world. The question arises whether these environmental changes had an impact on general motor performance in children and adolescents. The study aimed to investigate secular trends of motor performance in Swiss children and adolescents, aged between 7 and 18 years, over a period of 35 years from 1983 to 2018. Longitudinal data on the five motor components of the Zurich Neuromotor Assessment (ZNA) - pure motor (PM), fine motor (FM), dynamic balance (DB), static balance (SB), and contralateral associated movements (CAM) - were pooled with cross-sectional data on PM and FM from eight ZNA studies between 1983 and 2018. Regression models were used to estimate the effect of the year of birth on motor performance and body mass index (BMI) measurements. Models were adjusted for age, sex, and socioeconomic status. The secular trend estimates in standard deviation scores (SDS) per 10 years were - 0.06 [-0.33; 0.22, 95% Confidence Interval] for PM, -0.11 [-0.41; 0.20] for FM, -0.38 [-0.66; -0.09] for DB (-0.42 when controlled for BMI), -0.21 [-0.47; 0.06] for SB, and - 0.01 [-0.32; 0.31] for CAM. The mean change in BMI data was positive with 0.30 SDS [0.07; 0.53] over 10 years. Despite substantial societal changes since the 1980s, motor performance has remained relatively stable across generations. No secular trend was found in FM, PM, SB, and CAM over a period of 35 years. A secular trend in DB was present independent of the secular trend in body mass index.

Prediction of voluntary movements of the upper extremities by resting state‐brain regional glucose metabolism in patients with chronic severe brain injury: A pilot study

Confirmation of the exact voluntary movements of patients with disorder of consciousness following severe traumatic brain injury (TBI) is difficult because of the associated communication disturbances. In this pilot study, we investigated whether regional brain glucose metabolism assessed by 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) at rest could predict voluntary movement in severe TBI patients, particularly those with sufficient upper limb capacity to use communication devices. We visually and verbally instructed patients to clasp or open their hands. After video capture, three independent rehabilitation therapists determined whether the patients' movements were voluntary or involuntary. The results were compared with the standardized uptake value in the primary motor cortex, referring to the Penfield's homunculus, by resting state by FDG-PET imaged 1year prior. Results showed that glucose uptake in the left (p=0.0015) and right (p=0.0121) proximal limb of the primary motor cortex, based on Penfield's homunculus on cerebral cartography, may reflect contralateral voluntary movement. Receiver operating characteristic curve analysis showed that a mean cutoff standardized uptake value of 5.47 ± 0.08 provided the best sensitivity and specificity for differentiating between voluntary and involuntary movements in each area. FDG-PET may be a useful and robust biomarker for predicting long-term recovery of motor function in severe TBI patients with disorders of consciousness.