Mixed Nerve Stimulation Research Articles

Peripheral Silent Period In Cervical and Generalized Dystonia

Objective: Dystonia is a movement disorder described by continuous or alternating muscle contractions causing unusual postures or insistent motions. Abnormal sensorimotor integration and abnormalities in inhibitory pathways are thought to have a role in pathogenesis. This paper aims to research the state of inhibitory pathways in the spinal cord in dystonia through documenting a silent period (SP) through cutaneous stimulation (CuSP) or mixed nerve stimulation (MnSP).
 Methods: 23 patients with dystonia were included in the study. Also, 19 healthy subjects were included in the study as a control group. Ages were similar between two groups. (p=0.092). CuSP and MnSP are recorded through abductor pollicis brevis and median nerve at the wrist respectively. 
 Results: Onset latency, time, and suppression index of CuSP were equivalent between two groups. Moreover, the initiation and terminate latencies of MnSP, also duration, were similar between these two groups. I2 suppression index was lower in generalized dystonia patients compared to patients with cervical dystonia (100.0 vs 86.7±21.4%; F=4.252, 0.035). 
 Conclusions: The most striking result to emerge from the data is that there was lower suppression during CuSP in generalized dystonia patients. Our results suggest that spinal inhibitory circuits are less active if only there is clinical involvement of the relevant segment.

Excitatory and inhibitory responses to cervical root magnetic stimulation in healthy subjects

ObjectivesTo characterize direct and reflex hand muscle responses to cervical root magnetic stimulation (CRMS) in healthy volunteers during sustained voluntary contraction. MethodsIn 18 healthy volunteers, we recorded from the first dorsal interosseous (FDI) muscle the responses to CRMS of progressively increasing intensity and level of muscle contraction. The compound muscle action potential (CMAP) and the silent period (SP) were compared to those obtained with plexus, midarm and wrist stimulation. Additionally, in a smaller number of subjects, we obtained the peristimulus time histogram (psth) of single motor unit firing in the FDI, examined the effects of vibration and recorded the modulation of sustained EMG activity in muscles of the lower limbs. ResultsIncreasing CRMS intensity led to larger CMAP with no relevant changes in SP1 or SP2, except for lower amplitude of the burst interrupting the silent period (BISP). Increasing the level of muscle contraction led to reduced CMAP, shorter SP duration and increased BISP amplitude. The psth analysis showed the underlying changes in the motor unit firing frequency that corresponded to the changes seen in the CMAP and the SP with surface recordings. Progressively distal stimulation led to CMAPs of shorter latency and increased amplitude, SPs of longer latency and shorter duration, and a BISP of longer latency. Vibration led to reduction of the SP. CRMS induced SPs in muscles of the lower limb. ConclusionsCRMS induces excitatory and inhibitory responses in hand muscles, fitting with the expected behavior of mixed nerve stimulation at very proximal sites. SignificanceCharacterization of the effects of CRMS on hand muscles is of physiological and potentially clinical applicability, as it is a painless and reliable procedure.

Long Latency Reflexes in Patients with Postural Instability and Ataxia

Objectives: Distal electrical stimulation of an upper extremity mixed nerve can generate a reflex response from the trapezius muscle. This reflex response may have a central neural pathway and can be affected by postural changes. Materials and Methods: In this study, long latency reflexes (LLRs) from both distal and trapezius muscle were evaluated in patients with Parkinson's disease (PD) with and without postural dysfunction and in patients with cerebellar ataxias. Thirty-three patients with PD, 10 patients with degenerative cerebellar ataxia and 22 healthy volunteers were included in the study. LLRs were recorded from ipsilateral thenar and trapezius muscles. Latencies and amplitudes of LLRs obtained from thenar (thenar LLR) and trapezius (trapezius LLR) muscles were analyzed. Results: In patients with PD, thenar LLRs showed significant shortening in the onset latencies and significant increase in the amplitudes in comparison with healthy controls. Trapezius LLRs did not show any significant difference in latencies or amplitudes; however, these responses showed a significant absence in one or two components in patients with Parkinson's disease with postural dysfunction. Additionally, this reflex was not recorded in patients with cerebellar ataxia. Conclusion: Trapezius LLRs can give some information regarding the physiology of neural circuits responsible for postural arrangement. Cerebellar connections may have a major role in the generation of trapezius LLRs.

P252 Prepulse inhibition of blink reflex after different types of somatosensory stimuli

Objective Prepulse inhibition (PPI) is a neurophysiological method in which inhibition of a reflex response occurs when a preceding stimulus is applied. It is generally created by digital somatosensory stimulation. R2 magnitude gets reduced using certain interstimulus intervals (ISIs) whereas short ISI leads to facilitation of R1. We aimed to analyze the changes of BR-PPI using digital somatosensory stimulation and mixed nerve stimulation at wrist. Patients and method We included 18 healthy subjects (38.8 ± 10.9 years, 12 women) and performed BR investigations after unconditioned and conditioned supraorbital electrical stimuli. For conditioned stimuli, we applied two different preceding subthreshold somatosensory stimuli: i. stimulation of second finger, ii. stimulation of median nerve at wrist. Three different ISIs (50, 100, 300 ms) were used for each type of stimulation. Presence and extent of alteration after each conditioning stimulus were compared. Results R2 area significantly reduced after each conditioning stimulus at each ISI. R2 latency was longer at ISIs of 100 and 300 ms whereas R1 magnitude was higher at all ISIs. However, the increase in R1 magnitude was more pronounced at ISIs of 50 and 100 ms. Conclusions Our results clearly show that both digital somatosensory and mixed nerve stimulations lead to inhibition of R2 area and facilitation of R1 magnitude. Therefore, both stimulations and both techniques are comparable.

ID 263 – Effects of short-term vibration on mixed nerve silent period

Aim Following the electrical stimulation of mixed nerve during voluntary muscle contraction, temporarily suppressed EMG activation called mixt nerve silent period (MNSP). MNSP is interrupted by several bursts; first one is segmental reflex (SR) and others known as a long-loop reflexes(LLR). Vibration has been shown suppress the segmental H-reflex amplitude by increasing Ia afferent discharge. In this study, our aim was to provide insight into SR characteristics and the effects of vibration on other parameters. Method Eleven healthy volunteer (5 women, 33.36 ± 5.35 years) included the study. Vibration was applied for 2 min at 100 Hz with repositioning amplitude of 1 mm on right forearm. Median nerve stimulated at wrist during thumb abduction and MNSP recorded at baseline, during and after the vibration application. Latencies of SR, LLR and MNSP and amplitudes of SR and LLR compared for each session. Results Average SR and LLR amplitudes, MNSP durations before, during and after vibration were found as (1093.36 ± 606.16/877.22 ± 390.37/863.0 ± 604.51), (561.17 ± 353.8/1363.92 ± 1242.78/1100.0 ± 901.65) and (108.6 ± 12.41/113.55 ± 21.35/100.47 ± 18.03) respectively. MNSP durations, SR and LLR latencies were not significantly different between sessions. While SR amplitude tended to decrease, LLRA tended to increase. Conclusion Present study demonstrated that short-therm vibration is not effective on MNSP parameters. Our results may support that SR share similar characteristics with HR.

An electrodiagnostic technique for assessing palmar proper digital nerves of the hand: Normative data and clinical application.

There is no standard electrodiagnostic technique for palmar proper digital nerves (PaPDNs). In this study we investigated sensory nerve action potentials (SNAPs) to PaPDN stimulation in normal subjects and patients. SNAPs of PaPDNs were recorded in response to selective antidromic stimulation at the web space and mixed nerve stimulation at the wrist in 14 controls. The selectivity of PaPDN stimulation and the effect of recording electrode position on SNAP amplitude were studied. The technique was tested in 2 patients with PaPDN lesions. The technique yielded selective PaPDN stimulation at the web space. SNAP amplitude to PaPDN stimulation was influenced by age and was larger than SNAP amplitude to wrist stimulation. The recording electrode positions influenced SNAP amplitude. In patients, we documented PaPDN lesions, which were confirmed at surgery, whereas conventional wrist mixed nerve stimulation yielded negative findings. Selective PaPDN stimulation at the web space is feasible and may be helpful for electrodiagnosis of PaPDN lesions.

A randomised, controlled study of small intestinal motility in patients treated with sacral nerve stimulation for irritable bowel syndrome.

BackgroundIrritable bowel syndrome (IBS) is among the most common gastrointestinal disorders worldwide. In selected patients with severe diarrhoea-predominant or mixed IBS subtypes sacral nerve stimulation (SNS) alleviates IBS-specific symptoms and improves quality of life. The mode of action, however, remains unknown. The present study aimed to evaluate the effect of SNS on small intestinal motility in IBS patients.MethodsTwenty patients treated with SNS for severe diarrhoea-predominant or mixed IBS were included in a randomised, controlled, crossover study. The neurostimulator was turned ON or OFF for the first one month and then to the opposite setting for the next month. Gastrointestinal transit patterns were investigated with the Motility Tracking System-1 (MTS-1) at the end of each the ON and OFF period. Primary endpoint was change in the velocity of the magnetic pill within the small intestine. Statistical testing was performed with Wilcoxon’s rank sum test and Fisher’s exact test.ResultsThe median velocity of the magnetic pill through the small intestine in the fasting state was not significantly different between periods with and without SNS (Group ON-OFF: median change 0 m/h (range -1.07, 0.63), Group OFF-ON: median change 0.27 m/h (range -0.59, 1.12)) (p = 0.25). Neither, was the median velocity of the magnetic pill through the small intestine in the postprandial state significantly different between periods with and without SNS (Group ON-OFF: median change -0.13 m/h (range -0.46, 0.23), Group OFF-ON: median change 0.015 m/h (range -0.48, 0.59)) (p = 0.14).ConclusionEven though SNS may reduce symptoms of diarrhoea-predominant and mixed IBS, it has no detectable effect on small intestinal transit patterns.Trial registrationClinical.trials.gov, (NCT00919672).

119. Dermatomal sensory evoked potentials in sensory neuropathies of lower limb

Peripheral neuropathies of sensory nerves in thighs and legs are uncommon and also hard to confirm by neurophysiologic tests. Often neurography and somatosensory evoked potentials from mixed nerve stimulation are not enough selective, sensitive or even useable in those clinical hypothesis. Dermatomal sensory evoked potentials (dSEP) obtained stimulating cutaneous regions with a specific innervation can be an useful tool to investigate those neuropathies. The key of this method, because of frequent anatomic variants and topographic embedding of terminal nerve fibres, is that maximum care must be placed in the choice of cutaneous regions to stimulate. In our experience, we found some cases in which dSEP confirmed a clinical suspicion of sensitive neuropathy. We studied Genitofemoral, Iliohypogastric, Ilioinguinal, Lateral Femoral Cutaneous, Saphenous, Calcanear nerves. We will present our normative data and some case reports.

Reflex control of posterior shoulder muscles from arm afferents in healthy people

In order to position the hand during functional tasks, control of the shoulder is required. Heteronymous reflexes from the upper limb to shoulder muscles are used to assist in this control. To investigate this further, the radial and ulnar nerves were stimulated at elbow level whilst surface electromyographic activity of posterior deltoid, infraspinatus and latissimus dorsi muscles were recorded. In addition, the cutaneous branch of the radial nerve and the skin of the fifth digit were stimulated in order to investigate any cutaneous contribution to reflex activity. Reflexes were evoked in all three of these shoulder muscles from hand and/or forearm afferents. However, the reflexes differed; whereas both excitatory and inhibitory reflexes were evoked in posterior deltoid and infraspinatus, the reflexes in latissimus dorsi were mainly excitatory. Cutaneomuscular reflexes were seldom evoked here, but when they were present they were generally evoked at longer latencies than the reflexes evoked by mixed nerve stimulation. The results suggest a role for reflexes originating from the forearm and/or hand in the control of the shoulder.

Plasticity in human motor cortex is in part genetically determined

Brain plasticity refers to changes in the organization of the brain as a result of different environmental stimuli. The aim of this study was to assess the genetic variation of brain plasticity, by comparing intrapair differences between monozygotic (MZ) and dizygotic (DZ) twins. Plasticity was examined by a paired associative stimulation (PAS) in 32 healthy female twins (9 MZ and 7 DZ pairs, aged 22.6±2.7 and 23.8±3.6 years, respectively). Stimulation consisted of low frequency repetitive application of single afferent electric stimuli, delivered to the right median nerve, paired with a single pulse transcranial magnetic stimulation (TMS) for activation of the abductor pollicis brevis muscle (APB). Corticospinal excitability was monitored for 30 min following the intervention. PAS induced an increase in the amplitudes of the motor evoked potentials (MEP) in the resting APB, compared to baseline. Intrapair differences, after baseline normalization, in the MEP amplitudes measured at 25-30 min post-intervention, were almost double for DZ (1.25) in comparison to MZ (0.64) twins (P =0.036). The heritability estimate for brain plasticity was found to be 0.68. This finding implicates that genetic factors may contribute significantly to interindividual variability in plasticity paradigms. Genetic factors may be important in adaptive brain reorganization involved in motor learning and rehabilitation from brain injury.

Methyl bromide myoclonus: an electrophysiological study

We report a case of myoclonus from overnight exposure to methyl bromide. Myoclonus was either spontaneous or induced by somatosensory stimulation or voluntary movements, multifocal and sometimes generalized. Median SEP showed normal size P14-N20, but giant parietal P25, N33 and frontal P22-N30 waves. Back-averaging showed a biphasic EEG spike of maximal amplitude at the central region contralateral to the corresponding myoclonic jerk recorded from abductor pollicis brevis and preceding it by a short interval consistent with conduction in corticospinal pathways. Long latency reflexes from cutaneous and mixed nerve stimulation were enhanced. The above electrophysiological findings suggest that myoclonus following methyl bromide poisoning belongs to the cortical reflex myoclonus category.

Short-interval intracortical inhibition is modulated by high-frequency peripheral mixed nerve stimulation

Cortical excitability can be modulated by manipulation of afferent input. We investigated the influence of peripheral mixed nerve stimulation on the excitability of the motor cortex. Motor evoked potentials (MEPs), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) in the right abductor pollicis brevis (APB), extensor carpi radialis (ECR) and first dorsal interosseous (FDI) muscles were evaluated using paired-pulse transcranial magnetic stimulation (TMS) before and after high-frequency peripheral mixed nerve stimulation (150 Hz, 30 min) over the right median nerve at the wrist. The MEP amplitude and SICI of the APB muscle decreased transiently 0-10 min after the intervention, whereas the ICF did not change. High-frequency peripheral mixed nerve stimulation reduced the excitability of the motor cortex. The decrement in the SICI, which reflects the function of GABA(A)ergic inhibitory interneurons, might compensate for the reduced motor cortical excitability after high-frequency peripheral mixed nerve stimulation.

PRP-1 Protective Effect against Central and Peripheral Neurodegeneration following n. ischiadicus Transection

We investigated the action of the new hypothalamic proline-rich peptide (PRP-1), normally produced by neurosecretory cells of hypothalamic nuclei (NPV and NSO), 3 and 4 weeks following rat sciatic nerve transection. The impulse activity flow of interneurons (IN) and motoneurons (MN) on stimulation of mixed (n. ischiadicus), flexor (n. gastrocnemius--G) and extensor (n. peroneus communis--P) nerves of both injured and symmetric intact sides of spinal cord (SC) was recorded in rats with daily administration of PRP-1 (for a period of 3 weeks) and without it (control). On the injured side of SC in control, there were no responses of IN and MN on ipsilateral G and P stimulation, while responses were elicited on contralateral nerve stimulation. The neuron responses on the intact side of SC were revealed in a reverse ratio. Thus, there were no effects upon stimulation of the injured nerve distal stump in the control because of the absence of fusion between transected nerve stumps. This was also testified by the atrophy of the distal stump and the absence of motor activity of the affected limb. In PRP-1-treated animals, the responses of SC IN and MN in postaxotomy 3 weeks on the injured side of SC at ipsilateral nerve stimulation and on the intact side at contralateral nerve stimulation were recorded because of the obvious fusion of the severed nerve stumps. The histochemical data confirmed the electrophysiological findings. Complete coalescence of transected fibers together with restoration of the motor activity of the affected limb provided evidence for reinnervation on the injured side. Thus, it may be concluded that PRP-1 promotes nerve regeneration and may be used clinically to improve the outcome of peripheral nerve primary repair.

Neuroprotective Action of Hypothalamic Peptide PRP-1 at Various Time Survivals Following Spinal Cord Hemisection

The purpose of the present study was to evaluate the neuroprotective action of proline-rich peptide-1 (PRP-1) produced by hypothalamic nuclei cells (nuclei paraventricularis and supraopticus) following lateral hemisection of spinal cord (SC). The dynamics of rehabilitative shifts were investigated at various periods of postoperative survival (1-2, 3, and 4 weeks), both with administration of PRP-1 and without it (control). We registered evoked spike flow activity in both interneurons and motoneurons of the same segment of transected and symmetric intact sides of SC and below it on the stimulation of mixed (n. ischiadicus), flexor (n. gastrocnemius) and extensor (n. peroneus communis) nerves. In the control group (administration of 0.9% saline as placebo), no significant decrease of post-stimulus activity of neurons was observed on the transected side by the 2nd week. This activity strongly decreased by week 3 postaxotomy, with some increase on the intact side, possibly of compensatory origin. No shifts occurred by the 4th week. Regardless of the period of administration, PRP-1 increased neuronal activity on the transected side, with the same activation levels on both SC sides. These data were confirmed by histochemical investigation. PRP-1 administration, both daily and every other day, for a period of 2-3 weeks led to prevention of scar formation and promotion of the re-growth of white matter nerve fibers in the damaged area. It also resulted in prevention of neuroglial elements degeneration and reduction in gliosis expression in the lesion supporting neuronal survival. Thus, PRP-1 achieved protection against "tissue stress", which was also confirmed by the registration of activity on the level of transection and restoration of the motor activity on the injured side. The obtained data propose the possibility of PRP-1 application in clinical practice for prevention of neurodegeneration of traumatic origin.

Efficacy of Transcutaneous Electrical Nerve Stimulation for Osteoarthritis of the Lower Extremities: a Meta-analysis

Although transcutaneous electrical nerve stimulation is commonly used to treat the pain of osteoarthritis, the effectiveness of this type of stimulation for pain relief remains controversial. This review found statistically significant results favouring conventional and acupuncture-like stimulation for pain relief and stiffness relief. Mixed stimulation was effective in reducing knee pain but had less effect on hip pain. Burst nerve stimulation resulted in statistically significant relief of knee stiffness and increase in long-term pain relief. Conventional, burst, acupuncturelike, and mixed transcutaneous electrical nerve stimulation have some benefit over placebo for certain aspects of osteoarthritis-associated disability, and can be used as an adjunct therapy for treatment of patients with arthritis involving the hips and/or knees.

The effects from lumbar nerve root transection in rats on spinal somatosensory and motor-evoked potentials.

Spinal somatosensory-evoked potentials (SSEPs), elicited by mixed nerve and dermatomal stimulation, and compound evoked muscle potentials (CMAPs), elicited by lower thoracic interspinous space stimulation, were recorded in rats that underwent single nerve root transection. To investigate and compare the effects of single nerve root transection using various electrophysiological models and to define a monitoring strategy that can easily and accurately predict compromise caused by a single lumbosacral nerve root injury. Neuromonitoring is an important and effective preventive measure against neurologic complications during spinal surgery, but monitoring the lumbosacral nerve roots is not well established. Rats received (Group I) a sham operation or had the (Group II) left L4, (Group III) L5, or (Group IV) L6 nerve root transected. SSEP were recorded at the thoracolumbar junction following stimulation of the sciatic nerve (M-SSEP) and the L5 dermatome (D-SSEP). CMAP was recorded at the intrinsic muscles of the foot by electrical stimulation in the lower thoracic spinal cord. Potentials recorded before and after a single nerve root transection were compared and correlated with clinical status by walking-track analysis 1 week later. Relative amplitudes in Group II were 54.1% (M-SSEP), 84.6% (D-SSEP), and 85.5% (CMAP); 25.2% (M-SSEP), 66.5% (D-SSEP), and 85.8% (CMAP) in Group III; and 66.5% (M-SSEP), 95.5% (D-SSEP), and 23.2% (CMAP) in Group IV. M-SSEP is sensitive but not specific to single nerve root injury. D-SSEP and CMAP are less sensitive but more specific. Injury to a single lumbosacral nerve root is diagnosed more easily with M-SSEP. With D-SSEP and CMAP, it was possible to differentiate the lesioned nerve root by stimulating the primary dermatome or recording from the innervated muscle. M-SSEP is an easy-sampling and appropriate tool for screening nerve root injury; its poor specificity may be overcome by using D-SSEP and CMAP in addition. Optimal monitoring of the lumbosacral nerve roots during lumbar spinal surgery requires the administration of M-SSEP, D-SSEP, and CMAP to provide independent verification of lumbosacral nerve root integrity and to allow detection of the occasional injuries that selectively affect either the sensory or motor system.

Registro de potenciales evocados somatosensoriales dermatómicos en punto de ERB, médula cervical y corteza cerebral en el diagnóstico de la radiculopatía cervical

Recording at various levels of the somatosensory pathway is often used in somatosensory evoked potentials to mixed nerve stimulation (SEP), but not in dermatomal somatosensory evoked potentials (DSEP) in which only the cortical potential is usually recorded. The aim of our study was to compare the recordings of upper limb DSEP at Erb point, cervical cord, and subcortical and cortical levels with SEP recordings in healthy subjects and patients with cervical radiculopathy. 17 patients with clinical history, MRI and electromyography consistent with cervical radiculopathy and 17 healthy subjects were included. Median and ulnar nerves were stimulated at the wrist; and C6, C7 and C8 dermatomes at the 1st, 3rd and 5th fingers respectively. All the potentials obtained with SEP and DSEP were compared between controls and patients by t test for independent samples. We also used Pearson s correlation for height/latencies, weight/amplitude and age/peripheral nerve conduction velocity (PNCV). DSEP potentials were of similar morphology of those observed in SEP but had longer latencies and smaller amplitudes. We found a positive correlation between height and latencies, and a negative association of weight with amplitude of peripheral potential, and age/PNCV. No difference between controls and the neurological intact segments of patients was found. 13 patient had DSEP altered while only 5 of them had altered SEP recorded. The most common finding was prolongation of the conduction time of the segment N9 N13 on DSEP recordings. We found that it is possible to record and to identify all the potentials in DSEP as observed in the SEP. On cervical radiculopathy, DSEP with the present technique increase the sensitivity and give some additional and useful information regarding the extension and localization of the pathology. Besides, DSEP recording is a non invasive technique, non traumatic and well tolerated for our patients.

Reduction of the muscle activity associated with self-imposed electrical stimulation of mixed nerves supplying lower limb muscles in man

Similarly to brief hammer taps self-imposed on the limb segments, self-triggered electrical stimulation delivered to the tibial, femoral or peroneal nerves are associated with anticipatory reduction in the muscle activity (RMA) of the target leg muscles. The anticipatory RMA starts shortly before the expected perturbation and lasts until the onset of the impact. The purpose of the present work is to study to what extent the selective activation of the different homonymous and heteronymous afferents could modify the central programs and the associated time and space distribution of the anticipatory RMA pattern in the target leg muscles. Our results show that the anticipatory RMA pattern is a result mainly of a pre-programmed non-specific central command, rather than consequence of the specific composition of the afferent volleys originating from different homonymous and heteronymous nerves. The commands for the voluntary movement triggering the stimulation and the associated anticipatory RMA are closely linked but independently controlled. By their synchronisation and co-ordination the central nervous system accounts the differences in length of the particular motor pathways. It is suggested, that in contrast to the classic anticipatory postural adjustments, the anticipatory RMA is presumably an alternative mode of feed-forward control diminishing the undesired effects of the afferent inputs.

Hyperexcitable cortical responses in progressive myoclonic epilepsy: a TMS study.

Transcranial magnetic stimulation (TMS) has allowed investigators to study intracortical inhibition and facilitation and sensorimotor integration in motor disorders and epilepsy. The authors used TMS to elucidate the pathophysiology of reflex myoclonus with giant somatosensory evoked potentials (SEP). The authors studied four patients with progressive myoclonic epilepsy. All patients had giant SEP elicited by mixed and digital nerve stimulation. They studied the response to paired-pulse TMS at interstimulus intervals (ISI) ranging from 1 to 15 ms and the conditioning effect of digital electrical stimulation at ISI ranging from 10 to 100 ms on the motor evoked potential amplitude to TMS. Digital stimulation markedly facilitated conditioned motor evoked potentials at ISI ranging from 25 to 40 ms in all patients. This pattern was significantly different from the inhibition observed in controls (n = 12) at the same ISI. In the patients, paired-pulse TMS showed a decrease in intracortical inhibition in the motor cortex in comparison with controls. These findings suggest cortical and subcortical components of abnormal sensorimotor integration in addition to hyperexcitability of the sensory and motor cortex in our myoclonic patients.

Effect of muscle activation on SEP dynamics: Comparison between sensory and mixed nerve stimulation

Effect of muscle activation on SEP dynamics: Comparison between sensory and mixed nerve stimulation