Electrical Stimulation Of Motor Cortex Research Articles

P36.30 Modification of event related beta synchronization induced by motor cortex electrical stimulation for control of neuropathic pain

P36.30 Modification of event related beta synchronization induced by motor cortex electrical stimulation for control of neuropathic pain

The Cerebellum Modulates Rodent Cortical Motor Output after Repetitive Somatosensory Stimulation

To analyze the possible role of the cerebellum in the modulation of cortical motor output associated with repetitive electrical stimulation of the sciatic nerve in the rat. A sustained somatosensory stimulation induces an increase in the intensity of the response of the rodent motor cortex. Wistar rats were anesthetized for surgical preparation using a continuous infusion of chloral hydrate. We analyzed the response evoked by electrical stimulation of the right motor cortex before (basal condition) and after peripheral electrical stimulation of the left sciatic nerve in rats with no cerebellar intervention (n = 6), and in control rats with Ringer's infusion via a microdialysis probe (n = 8) implanted in the left cerebellar nuclei. In addition, we investigated the effects of 1) the administration of ethanol (20 mmol/L) in the left cerebellar nuclei (n = 5); 2) the administration of tetrodotoxin (10 micromol/L), a sodium channel blocker, in the left cerebellar nuclei (n = 5); 3) electrical stimulation by deep cerebellar stimulation (frequency 100 Hz) on the left side (n = 5); or 4) electrical stimulation of the cerebellar nuclei on the right side (100 Hz; n = 6). For peripheral stimulation, all of the animals received 1 hour of electrical stimulation. Trains of stimulation consisted of five stimuli (duration of 1 stimulus, 1 ms) at a rate of 10 Hz. During stimulation of the motor cortex, peak-to-peak amplitudes in responses of the left calf muscle were analyzed. Motor threshold was defined as the lowest intensity eliciting at least 5 of 10 evoked responses with an amplitude greater than 20 muV. The intensity used was 130% of the motor threshold. In the basal condition (before repetitive stimulation), amplitudes of motor responses were similar in the six groups of rats (P = 0.40). In rats without cerebellar intervention, peripheral electrical stimulation was associated with an increase of motor response to 147.4 +/- 8.5% of baseline (P < 0.001). In rats with Ringer's infusion, the motor response increased to 141.6 +/- 7.9% of baseline (P < 0.001). The administration of ethanol in the cerebellum prevented the enhancement of the response ipsilaterally. The mean +/- standard deviation (SD) of motor responses was 105.7 +/- 6.2% of baseline measurements after stimulation of the sciatic nerve (P = 0.36). The same observation was made after the infusion of tetrodotoxin (mean +/- SD of motor responses: 107.1 +/- 7.4% after peripheral stimulation [P = 0.19] and after electrical stimulation of the cerebellum on the left side [mean +/- SD of motor responses, 104.3 +/- 8.5% after peripheral stimulation, P = 0.40]). However, electrical stimulation of cerebellar nuclei on the right side did not impair the modulation of cortical motor output by sciatic nerve stimulation (mean +/- SD of motor responses, 148.4 +/- 5.8% after peripheral stimulation, P < 0.001). Until now, the increase of motor output after peripheral nerve stimulation has been considered as a plasticity directly and solely dependent on cortical structures. We demonstrate that the cerebellum plays a key role in this form of neural plasticity.

Spinal dorsal horn neuron response to mechanical stimuli is decreased by electrical stimulation of the primary motor cortex

Motor cortex stimulation (MCS) has been used clinically as a tool for the control for central post-stroke pain and neuropathic facial pain. The underlying mechanisms involved in the antinociceptive effect of MCS are not clearly understood. We hypothesize that the antinociceptive effect is through the modulation of the spinal dorsal horn neuron activity. Thirty-two wide dynamic range spinal dorsal horn neurons were recorded, in response to graded mechanical stimulation (brush, pressure, and pinch) at their respective receptive fields, while a stepwise electrical stimulation was applied simultaneously in the motor cortex. The responses to brush at control, 10 V, 20 V, and 30 V, and recovery were 11.5 ± 1.6, 12.1 ± 2.6, 11.1 ± 2.2, 10.5 ± 2.1, and 13.2 ± 2.5 spikes/s, respectively. The responses to pressure at control, 10 V, 20 V, and 30 V, and recovery were 33.2 ± 6.1, 22.9 ± 5.3, 20.5 ± 5.0, 17.3 ± 3.8, and 27.0 ± 4.0 spikes/s, respectively. The responses to pinch at control, 10 V, 20 V, and 30 V, and recovery were 37.2 ± 6.4, 26.3 ± 4.7, 25.9 ± 4.7, 22.5 ± 4.3, and 35.0 ± 6.2 spikes/s, respectively. It is concluded that, in the rat, electrical stimulation of the motor cortex produces significant transient inhibition of the responses of spinal cord dorsal horn neurons to higher intensity mechanical stimuli without affecting their response to an innocuous stimulus.

Motor cortex stimulation for enhancement of recovery after stroke: Case report

We present a case report of a 65-year-old patient who had a subcortical infarct and a right spastic hemiparesis that occurred 19 months before being treated with an investigational therapy consisting of low frequency subthreshold epidural motor cortex electrical stimulation delivered during structured occupational therapy repeated daily for three weeks. Before treatment the patient's affected arm rested in a flexion posture and he was unable to flex or extend the fingers. After three weeks of treatment, the resting tone of his arm had improved and he was able to grasp a pen and write letters. The Fugl-Meyer motor scale score improved from 36 to 46 and this improvement was sustained for four weeks after the conclusion of rehabilitation therapy. This is the first patient to be entered into a randomized clinical feasibility and safety study assessing functional improvement in stroke patients treated with epidural cortical stimulation concurrent with occupational therapy (an investigational therapy).

Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways

Background This prospective study employs anisotropic diffusion-weighted (ADW) magnetic resonance imaging for the integration of individual spatial information concerning the principal motor pathways into the operating room during microneurosurgery in the central region. We hypothesize that the three-dimensional (3-D) visualization of the pyramidal tract position (PTV) in a neuronavigation system based on ADW provides valid information concerning the position and extension of the principal motor pathways. Methods A total of 13 consecutive patients with lesions adjacent to the pyramidal tracts and the central region underwent microneurosurgery with the help of pyramidal tract visualization (PTV). An ADW sequence obtained preoperatively was fused to an anatomic navigation sequence. The 3-D reconstructions of the precentral gyrus (PG), the pyramidal tract, and the tumor were available in a customized neuronavigation system during surgery. Intraoperatively the PG was identified on the basis of the aforementioned data. Electric motorcortex stimulation (CS) was used to directly verify the PG location and indirectly the fiber tract position. Results In 11 cases (92%) the prediction of the principal motor pathways' position was correct. In one case of a meningioma, according to PTV, the tumor was falsely localized postcentrally. In the case of a precentral cavernoma, no motor response could be elicited by cortical stimulation. Conclusion Intraoperative PTV on the basis of ADW provides the neurosurgeon with reliable information concerning the position of the principal motor pathways during intracranial procedures as proved with intraoperative electrophysiological testing. The technique has the potential to reduce operative morbidity. PTV is straightforward and can be adapted to other customized neuronavigation devices.

Differences in the BOLD fMRI response to direct and indirect cortical stimulation in the rat.

Functional MRI (fMRI) exploits a relationship between neuronal activity, metabolism, and cerebral blood flow to functionally map the brain. We have developed a model of direct cortical stimulation in the rat that can be combined with fMRI and used to compare the hemodynamic responses to direct and indirect cortical stimulation. Unilateral electrical stimulation of the rat hindpaw motor cortex, via stereotaxically positioned carbon-fiber electrodes, yielded blood oxygenation level-dependent (BOLD) fMRI signal changes in both the stimulated and homotypic contralateral motor cortices. The maximal signal intensity change in both cortices was similar (stimulated = 3.7 +/- 1.7%; contralateral = 3.2 +/- 1.0%), although the response duration in the directly stimulated cortex was significantly longer (48.1 +/- 5.7 sec vs. 19.0 +/- 5.3 sec). Activation of the contralateral cortex is likely to occur via stimulation of corticocortical pathways, as distinct from direct electrical stimulation, and the response profile is similar to that observed in remote (e.g., forepaw) stimulation fMRI studies. Differences in the neuronal pool activated, or neurovascular mediators released, may account for the more prolonged BOLD response observed in the directly stimulated cortex. This work demonstrates the combination of direct cortical stimulation in the rat with fMRI and thus extends the scope of rodent fMRI into brain regions inaccessible to peripheral stimulation techniques.

Intraoperative neurophysiologic monitoring for intramedullary spinal cord tumor surgery

Intraoperative neurophysiological monitoring is an integral part of surgery for intramedullary spinal cord tumors. Motor evoked potentials are the key technology for this purpose. Sensory evoked potentials play a limited role. Motor potentials are evoked by transcranial electrical motor cortex stimulation. The single-stimulus technique elicits D-waves, which are recorded from the spinal cord. The multipulse technique elicits muscle MEPs, which are recorded from limb muscles. The amplitude of the D-waves and the presence or absence of muscle MEPs are the critical parameters for MEP interpretation. The practical procedures for evoked potential recording are well suited to a neurosurgical environment, and the intraoperative interpretation and application of neurophysiological information is fast and straightforward, particularly for MEPs. MEPs can almost always be recorded in a patient who is not already severely disabled before surgery. Pre- and postoperative clinical motor findings correlate with the intraoperative MEP findings. As a result a patient's clinical status can be predicted any time during the operation with considerable certainty (the sensitivity of muscle MEPs for post-operative motor deficits is almost 100%; its specificity is about 90%). Therefore, MEP data reflect the clinical “reality” in an individual patient. Loss of muscle MEPs, interpreted in combination with an incremental decrease in the amplitude of the D-wave, provides a “window of warning.” It reflects a pattern of MEP change consistent with a reversible injury to the essential motor pathways. The surgical strategy can be adapted before irreversible neurological damage occurs. Present and stable recordings allow complete resection of tumors with confidence about the integrity of the motor pathways.

Basal ganglia and processing of cortical information: functional interactions between trans-striatal and trans-subthalamic circuits in the substantia nigra pars reticulata

The substantia nigra pars reticulata (SNR), a major output station of basal ganglia, receives information from the cerebral cortex through three main pathways, i.e. a direct inhibitory trans-striatal pathway, an indirect excitatory trans-striatal pathway that involves the pallidum and the subthalamus and a direct excitatory trans-subthalamic pathway. In order to determine how cortical information flow originating from functionally distinct cortical areas and processed through the trans-striatal and trans-subthalamic pathways is integrated within the SNR, the responses induced by electrical stimulation of prefrontal, motor and auditory cortex in SNR cells were analyzed in anesthetized rats. Further confirming that direct striato-nigral pathways related to these functionally distinct cortical areas are organized in parallel channels, stimulation of the prefrontal, motor and auditory cortex induced an inhibitory response on distinct subpopulations of SNR cells. Within a given channel, the direct trans-striatal and the trans-subthalamic pathways converge on a large number of nigral cells. In addition, the present study reveals that nigral cells receiving an inhibitory input from a given cortical area through the direct trans-striatal pathway can also receive an excitatory input from a functionally distinct cortical area through the trans-subthalamic pathways. Such a convergence mainly occurred between the direct striato-nigral pathway issued from the auditory cortex and the trans-subthalamic pathways issued from the motor cortex. These data reveal the existence of a converging influence of trans-subthalamic and direct striato-nigral pathways not only within but also across channels. Within a given cortico-basal ganglia channel, the trans-subthalamic pathways likely contribute to the temporal shaping of the striato-nigral inhibition and thus of the disinhibition of the related nigral target nuclei in the thalamus and mesencephalon. Across channels, the specific interactions between trans-subthalamic and direct striato-nigral pathways could contribute to prevent inhibition of subpopulations of nigral cells implicated in competing functions.

NEUROPHYSIOLOGICAL STUDY OF GENE THERAPY EFFECT ON MOUSE MODEL OF METACHROMATIC LEUKODYSTROPHY

Aim of the study: To evaluate with neurophysiological methods whether gene therapy may improve the abnormalities of motor system in mice with Metachromatic Leukodystrophy (MLD). Methods: 2 groups were studied: the first one consisted of 11 mice (AS2‐/‐) knocked‐out for Arylsulfatase A (ARSA) gene; the second one included 10 mice (AS2‐/‐tr) which, after lethal irradiation, were transplanted with autologous hematopoietic stem cells transducted with a retroviral vector containing the ARSA cDNA. Both groups underwent Motor Evoked Potentials (MEP) by transcranial electrical stimulation of motor cortex, as well as Motor Conduction Velocity (MCV) of ischiatic nerve and compared with a control group (n=11). Results: The mean latency of cortical MEP was shorter in AS2‐/‐tr than in AS2‐/‐ group of mice (4.9 ± 0.2 versus 6.8 ± 1.2 msec; p&lt;0.001), being quite similar to controls (5.1 ± 0.4 msec). The mean MCV was higher in AS2‐/‐tr as compared to AS2‐/‐ group (27.1 ± 4.5 versus 22.8 ± 3.0 m/sec; p&lt;0.05), even though significantly slower than controls (37.7 ± 3.8 m/sec). Comments: The neurophysiological data show that gene therapy seems to prevent ARSA deficient mice from developing a functional damage of corticospinal pathways. They also suggest that peripheral neuropathy has a slower course in mice treated with gene therapy, although motor nerve fibers are not completely spared.

Segregation and Convergence of Information Flow through the Cortico-Subthalamic Pathways

Cortico-basal ganglia circuits are organized in parallel channels. Information flow from functionally distinct cortical areas remains segregated within the striatum and through its direct projections to basal ganglia output structures. Whether such a segregation is maintained in trans-subthalamic circuits is still questioned. The effects of electrical stimulation of prefrontal, motor, and auditory cortex were analyzed in the subthalamic nucleus as well as in the striatum of anesthetized rats. In the striatum, cells (n = 300) presenting an excitatory response to stimulation of these cortical areas were located in distinct striatal territories, and none of the cells responded to two cortical stimulation sites. In the subthalamic nucleus, both prefrontal and motor cortex stimulations induced early and late excitatory responses as a result of activation of the direct cortico-subthalamic pathway and of the indirect cortico-striato-pallido-subthalamic pathway, respectively. Stimulation of the auditory cortex, which does not send direct projection to the subthalamic nucleus, induced only late excitatory responses. Among the subthalamic responding cells (n = 441), a few received both prefrontal and motor cortex (n = 19) or prefrontal and auditory cortex (n = 10) excitatory inputs, whereas a larger number of cells were activated from both motor and auditory cortices (n = 48). The data indicate that the segregation of cortical information flow originating from prefrontal, motor, and auditory cortices that occurred in the striatum is only partly maintained in the subthalamic nucleus. It can be proposed that the existence of specific patterns of convergence of information flow from these functionally distinct cortical areas in the subthalamic nucleus allows interactions between parallel channels.

Inhibition of biceps brachii muscle motor area by painful heat stimulation of the skin.

ract This study aimed to evaluate whether painful cutaneous stimuli can affect specifically the excitability of the arm proximal muscle motor area. The motor evoked potentials (MEPs), recorded from the right biceps brachii muscle after either transcranial magnetic or electrical anodal stimulation of the left primary motor (MI) cortex, were conditioned by painful CO2 laser stimuli delivered either on the right hand dorsum or on the lateral surface of the right arm. Painful CO2 laser stimuli delivered on the hand skin reduced significantly the amplitude of MEPs evoked by the transcranial magnetic stimulation of the contralateral MI area, while the MEP amplitude was not significantly modified by CO2 laser pulses delivered on the arm skin. The inhibitory effect followed the arrival of the nociceptive inputs to the cerebral cortex. The amplitude of MEPs evoked by anodal electrical stimulation of the motor cortex was not decreased by conditioning painful stimuli delivered on the hand dorsum. Since the magnetic stimulation led to transynaptic activation of pyramidal neurons, while the anodal stimulation activated directly corticospinal axons, our findings suggest that CO2 laser pulses delivered on the hand are able to inhibit the arm proximal muscle motor area.

Effects of a photic input on the human cortico-motoneuron connection

Objectives: Disease manifestations such as photic cortical reflex myoclonus or myoclonus due to intermittent light stimulation rely on a pathologic interaction between non-structured visual inputs and the corticospinal system. We wanted to assess the normal interaction, if any, between a prior photic input and the output of the cortico-motoneuron connection. Methods: In 9 consenting healthy subjects we quantified the changes exerted by a sudden, unexpected bright light flash on (i) the motor potentials (MEPs) evoked in the right first dorsal interosseous muscle (FDI) by transcranial magnetic or electrical stimulation (TMS/TES) of the primary motor cortex, (ii) the FDI F-waves and (iii) the soleus H-wave. Separately, we measured the simple reaction times to the flash itself. All determinations were repeated twice with an interval of 2–24 months. Results: When the flash preceded TMS by 55–70 ms, the MEP size was reduced, while at interstimulus intervals (ISIs) of 90–130 ms it was enlarged. Statistical significance ( P<0.05) emerged at ISIs of 55, 70, 100, 105 and 120 ms. Conversely, the MEP latency was prolonged at ISIs of 55–70 ms and shortened at ISIs of 90–130 ms ( P<0.05 at ISIs of 55, 110 and 130 ms). Electrical MEPs were enhanced at an ISI of 120 ms. The F-wave size showed a non-significant trend of enhancement at ISIs of 90–130 ms. The soleus H-wave showed significant enlargement at ISIs of 90–130 ms ( P<0.05 at ISIs of 100 and 105 ms). The minimum reaction time was on average 120 ms. Conclusions: An unexpected photic input, to which no reaction is planned, can cause an early inhibition of the responses to TMS. We think its origin lies within the primary motor cortex, since it is not associated with changes in spinal excitability or electrical MEPs. A later facilitation persists using TES and has a temporal relationship with an enlargement of the soleus H-wave. Thus, it likely results from activation of descending (possibly reticulospinal) fibers that excite the spinal motor nucleus.

Depression of I Waves in Corticospinal Volleys by Sevoflurane, Thiopental, and Propofol

Isoflurane depresses the number and amplitude of I waves of the motor-evoked potential produced by transcranial electrical stimulation of the motor cortex and thus affects components of the corticospinal volley that are believed to arise from Laminae III and V. This study extends these observations to sevoflurane (9 patients) and the two IV anesthetics, thiopental and propofol (10 sets of observations in 10 and 6 patients, respectively). The patients' ages ranged from 10 to 17 yr. Sevoflurane was administered to achieve end-tidal concentrations of 0.5%-3%. Thiopental and propofol were given as boluses of 5 mg/kg and 2 mg/kg, respectively, to patients anesthetized with nitrous oxide, fentanyl, midazolam, and a muscle relaxant. Sevoflurane had a depressant effect on I waves essentially similar to that of isoflurane; thiopental depressed I wave activity by an average of 33% (95% confidence interval: 20%-46%, P < 0.001) and propofol by 39% (95% confidence interval: 20%-40%, P < 0.001). With all three anesthetics, later I waves showed the most amplitude depression. The three anesthetics had qualitatively similar effects on I waves. Sevoflurane, thiopental, and propofol depress components of the corticospinal volley produced by transcranial electrical stimulation of motor cortex in a manner qualitatively similar to isoflurane. The findings indicate that anesthetics with primarily hypnotic actions suppress interneuronal activity in cerebral cortex.

Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study

Although electrical stimulation of the precentral gyrus (MCS) is emerging as a promising technique for pain control, its mechanisms of action remain obscure, and its application largely empirical. Using positron emission tomography (PET) we studied regional changes in cerebral flood flow (rCBF) in 10 patients undergoing motor cortex stimulation for pain control, seven of whom also underwent somatosensory evoked potentials and nociceptive spinal reflex recordings. The most significant MCS-related increase in rCBF concerned the ventral-lateral thalamus, probably reflecting cortico-thalamic connections from motor areas. CBF increases were also observed in medial thalamus, anterior cingulate/orbitofrontal cortex, anterior insula and upper brainstem; conversely, no significant CBF changes appeared in motor areas beneath the stimulating electrode. Somatosensory evoked potentials from SI remained stable during MCS, and no rCBF changes were observed in somatosensory cortex during the procedure. Our results suggest that descending axons, rather than apical dendrites, are primarily activated by MCS, and highlight the thalamus as the key structure mediating functional MCS effects. A model of MCS action is proposed, whereby activation of thalamic nuclei directly connected with motor and premotor cortices would entail a cascade of synaptic events in pain-related structures receiving afferents from these nuclei, including the medial thalamus, anterior cingulate and upper brainstem. MCS could influence the affective-emotional component of chronic pain by way of cingulate/orbitofrontal activation, and lead to descending inhibition of pain impulses by activation of the brainstem, also suggested by attenuation of spinal flexion reflexes. In contrast, the hypothesis of somatosensory cortex activation by MCS could not be confirmed by our results.

Motor-evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures

Resection of intramedullary spinal cord tumors carries a high risk for surgical damage to the motor pathways. This surgery is therefore optimal for testing the performance of intraoperative motor evoked potential (MEP) monitoring. This report attempts to provide evidence for the accurate representation of patients' pre- and postoperative motor status by combined epidural and muscle MEP monitoring during intramedullary surgery. The authors used transcranial electrical motor cortex stimulation to elicit MEPs, which were recorded from the spinal cord (with an epidural electrode) and from limb target muscles (thenar, anterior tibial) with needle electrodes. The amplitude of the epidural MEPs and the presence or absence of muscle MEPs were the parameters for MEP interpretation. A retrospective analysis was performed on data from the resection of 100 consecutive intramedullary tumors and MEP data were compared with the pre- and postoperative motor status. Intraoperative monitoring was feasible in all patients without severe preoperative motor deficits. Preoperatively paraplegic patients had no recordable MEPs. The sensitivity of muscle MEPs to detect postoperative motor deficits was 100% and its specificity was 91%. There was no instance in which a patient with stable MEPs developed a motor deficit postoperatively. Intraoperative MEPs adequately represented the motor status of patients undergoing surgery for intramedullary tumors. Because deterioration of the motor status was transient in all cases, it can be considered that impairment of the functional integrity of the motor pathways was detected before permanent deficits occurred.

Electrophysiological considerations regarding electrical stimulation of motor cortex and brain stem in humans.

To provide information about activation of descending motor pathways in humans, motor evoked potentials were obtained from 16 patients without any sensorimotor deficit, after both cortical and brain stem stimulation. Total anesthesia was achieved in all patients through intravenous administration. Short trains of one to five electrical pulses were delivered separately to the motor cortex and the brain stem. Compound muscle action potentials were recorded from the contralateral upper extremity. Threshold intensity, stimulus polarity, latencies, and effect of increased stimulus intensity on latencies were analyzed. The threshold intensity was significantly lower when stimulating the brain stem than when stimulating the cortex. A monophasic anodal stimulus was better for cortical stimulation than for brain stem stimulation. Conversely, a monophasic cathodal stimulus was more effective for brain stem stimulation. The rate of unsuccessful stimulations was higher with brain stem stimulation and with increased stimulation intensity. The variability of latencies was so high that a calculation of the conduction velocity of the motor pathways was not possible. The results indicate that cortical surface and brain stem stimulation act on different nervous elements. Because of the condensation of motor pathway fibers at the brain stem level, much less stimulus intensity for eliciting compound muscle action potentials was necessary. On the other hand, the higher rate of unsuccessful brain stem stimulations may be caused by a block of conduction at either the anterior horn cell pool or the neuromuscular junction. Thus, for cortical and for brain stem stimulation, different stimulating parameters seemed to be necessary with the patient under general anesthesia.

Tonic and bursting activity in the cuneate nucleus of the chloralose-anesthetized cat

Whole-cell recordings were obtained from cuneate neurons in anesthetized, paralysed cats. Stimulation of the contralateral medial lemniscus permitted us to separate projection cells from presumed interneurons. Pericruciate motor cortex electrical stimulation inhibited postsynaptically all the projection cells ( n=57) and excited all the presumed interneurons ( n=29). The cuneothalamic cells showed an oscillatory and a tonic mode of activity. Membrane depolarization and primary afferent stimulation converted the oscillatory to the tonic mode. Hyperpolarizing current steps applied to projection neurons induced a depolarizing sag and bursts of conventional spikes in current-clamp records. This indicates the probable existence of low-threshold and hyperpolarization-activated inward currents. Also, the hyperpolarization induced on projection cells by motor cortex stimulation deinactivated a low-threshold conductance that led to bursting activity. The presumed cuneate interneurons had larger and more proximally located peripheral receptive fields than the cuneothalamic cells. Finally, experiments specifically designed to test whether motor cortex-induced presynaptic inhibition could be postsynaptically detected gave negative results. These results demonstrate, for the first time, that the cuneothalamic cells possess both bursting and tonic firing modes, and that membrane depolarization, whether produced by injection of positive current or by primary afferent stimulation, converts the oscillatory into the tonic mode.

Assessment of corticospinal function in spinal cord injury using transcranial motor cortex stimulation: a review.

Other than clinical examination, few methods exist for assessing the functional condition of descending long tracts of the spinal cord in humans. This review covers neurophysiological examination of the corticospinal system using transcranial electrical and magnetic motor cortex stimulation. The neurophysiological basis for the motor evoked potentials (MEPs) and the differences between the two methods are discussed followed by a review of their use in individuals with spinal cord injury (SCI). Transcranial motor cortex stimulation is used to monitor descending spinal cord tract condition during spinal surgeries and could be useful for assessing central nervous system trauma, especially in the unconscious multitrauma patient. In the chronic phase of SCI, recordings of MEPs have enabled the estimation of central conduction times that relate to the condition of axons passing through the injured segment of the spinal cord. They were found to correlate well with clinical examination scores but as predictors of outcome, the reports have been mixed. The use of transcranial motor cortex stimulation to modify segmental reflexes and in combination with volitional attempts have also provided evidence of conduction across the lesion in paralyzed SCI subjects. However, MEPs can be absent in some SCI individuals who may be able to volitionally activate muscles below the level of the spinal cord lesion. Such findings are useful in elucidating the neural mechanisms underlying the performance of a volitional movement and may serve to guide and monitor the effects of future treatments for paralysis in SCI and other neurological disorders.

Effect of Isoflurane on Motor-evoked Potentials Induced by Direct Electrical Stimulation of the Exposed Motor Cortex with Single, Double, and Triple Stimuli in Rats

The clinical application of intraoperative motor-evoked potentials (MEPs) has been hampered by their sensitivity to anesthetics. Recently, to overcome anesthetic-induced depression of myogenic MEPs, multiple stimulus setups with a paired or a train of pulses for stimulation of the motor cortex were reported. However, the effects of anesthetics on MEPs induced by these stimulation techniques are unknown. Bipolar electrical stimulation of the left motor cortex was carried out in 15 rats anesthetized with thiopental while the compound muscle action potentials were recorded from the contralateral hind limb. After recording of the MEP in response to the single-shock stimulation of the motor cortex, paired pulses (double pulses) or a train of three pulses (triple pulses) with an interstimulus interval of each pulse at 0.3, 0.5, 1.0, 1.5, and 2.0 ms were applied. After control MEP recording, isoflurane was administered at a concentration of 0.25 minimum alveolar anesthetic concentration (MAC), 0.5 MAC, 0.75 MAC, and 1.0 MAC, and the effects of isoflurane on the MEPs induced by single, double, and triple pulses were evaluated. In all animals, distinct baseline MEPs were recorded. During the administration of 0.25 MAC and 0.5 MAC isoflurane, MEPs induced by stimulation with a single pulse could be recorded in 87% and 33% of animals, respectively, and MEP amplitude was significantly reduced in a dose-dependent manner. During the administration of 0.75 MAC isoflurane, MEPs after single-pulse stimulation could not be recorded in any animals. By stimulating with paired or triple pulses, the success rate of MEP recording and MEP amplitude significantly increased compared with those after single pulse before and during the administration of isoflurane. Both the success rate of MEP recording and MEP amplitude after double- and triple-pulse stimulation decreased significantly in a dose-dependent manner during the administration of isoflurane. Application of double or triple stimulation of the motor cortex increases the success rate of MEP recording and its amplitude during isoflurane anesthesia in rats. However, these responses are suppressed by isoflurane in a dose-dependent manner.

Functional magnetic resonance brain mapping during intracortical electrical stimulation of motor cortex

Functional magnetic resonance brain mapping during intracortical electrical stimulation of motor cortex