Awake Condition Research Articles

Dopamine D1 Receptor-Mediated Transmission Maintains Information Flow Through the Cortico-Striato-Entopeduncular Direct Pathway to Release Movements.

In the basal ganglia (BG), dopamine plays a pivotal role in motor control, and dopamine deficiency results in severe motor dysfunctions as seen in Parkinson's disease. According to the well-accepted model of the BG, dopamine activates striatal direct pathway neurons that directly project to the output nuclei of the BG through D1 receptors (D1Rs), whereas dopamine inhibits striatal indirect pathway neurons that project to the external pallidum (GPe) through D2 receptors. To clarify the exact role of dopaminergic transmission via D1Rs in vivo, we developed novel D1R knockdown mice in which D1Rs can be conditionally and reversibly regulated. Suppression of D1R expression by doxycycline treatment decreased spontaneous motor activity and impaired motor ability in the mice. Neuronal activity in the entopeduncular nucleus (EPN), one of the output nuclei of the rodent BG, was recorded in awake conditions to examine the mechanism of motor deficits. Cortically evoked inhibition in the EPN mediated by the cortico-striato-EPN direct pathway was mostly lost during suppression of D1R expression, whereas spontaneous firing rates and patterns remained unchanged. On the other hand, GPe activity changed little. These results suggest that D1R-mediated dopaminergic transmission maintains the information flow through the direct pathway to appropriately release motor actions.

Wakeful rest promotes the integration of spatial memories into accurate cognitive maps.

Flexible spatial navigation, e.g. the ability to take novel shortcuts, is contingent upon accurate mental representations of environments-cognitive maps. These cognitive maps critically depend on hippocampal place cells. In rodents, place cells replay recently travelled routes, especially during periods of behavioural inactivity (sleep/wakeful rest). This neural replay is hypothesised to promote not only the consolidation of specific experiences, but also their wider integration, e.g. into accurate cognitive maps. In humans, rest promotes the consolidation of specific experiences, but the effect of rest on the wider integration of memories remained unknown. In the present study, we examined the hypothesis that cognitive map formation is supported by rest-related integration of new spatial memories. We predicted that if wakeful rest supports cognitive map formation, then rest should enhance knowledge of overarching spatial relations that were never experienced directly during recent navigation. Forty young participants learned a route through a virtual environment before either resting wakefully or engaging in an unrelated perceptual task for 10 min. Participants in the wakeful rest condition performed more accurately in a delayed cognitive map test, requiring the pointing to landmarks from a range of locations. Importantly, the benefit of rest could not be explained by active rehearsal, but can be attributed to the promotion of consolidation-related activity. These findings (i) resonate with the demonstration of hippocampal replay in rodents, and (ii) provide the first evidence that wakeful rest can improve the integration of new spatial memories in humans, a function that has, hitherto, been associated with sleep.

Sleep compared to nocturnal wakefulness reduces the number of various T cell subsets in human blood

Circulating T cells show circadian rhythms, the direction and extent of which depend on the specific subset. Naive and memory T cells peak during nocturnal sleep, whereas cytotoxic effector T cells show an opposite rhythm with highest numbers during daytime. In the current study, we were interested in how sleep affects these different circadian rhythms and therefore measured 8 T cell subsets (naive, central memory, effector memory, and effector T-helper and cytotoxic T cells) over a 24-h period under conditions of sustained wakefulness compared to a normal sleep-wake cycle in 14 healthy males. Sleep significantly reduced the number of all T cell subsets during nighttime, except from effector T-helper cells. Sleep was furthermore associated with an increase in growth hormone, prolactin, and aldosterone levels, whereas concentrations of catecholamines tended to be lower than during nocturnal wakefulness. We propose that the decrease in catecholamine levels during sleep is responsible for the nocturnal reduction of cytotoxic effector T cells, which were shown in previous studies to selectively respond to epinephrine administration with a demargination. In contrast, the decrease of the less differentiated subsets during sleep is more likely to be a consequence of high growth hormone and aldosterone levels, two hormones that are suggested to support the extravasation and subsequent migration of naive and memory T cells to lymph nodes.

Asynchronous Distributed Multielectrode Microstimulation Reduces Seizures in the Dorsal Tetanus Toxin Model of Temporal Lobe Epilepsy.

Electrical brain stimulation has shown promise for reducing seizures in drug-resistant epilepsy, but the electrical stimulation parameter space remains largely unexplored. New stimulation parameters, electrode types, and stimulation targets may be more effective in controlling seizures compared to currently available options. We hypothesized that a novel electrical stimulation approach involving distributed multielectrode microstimulation at the epileptic focus would reduce seizure frequency in the tetanus toxin model of temporal lobe epilepsy. We explored a distributed multielectrode microstimulation (DMM) approach in which electrical stimulation was delivered through 15 33-µm-diameter electrodes implanted at the epileptic focus (dorsal hippocampus) in the rat tetanus toxin model of temporal lobe epilepsy. We show that hippocampal theta (6-12 Hz brain oscillations) is decreased in this animal model during awake behaving conditions compared to control animals (p < 10(-4)). DMM with biphasic, theta-range (6-12 Hz/electrode) pulses delivered asynchronously on the 15 microelectrodes was effective in reducing seizures by 46% (p < 0.05). When theta pulses or sinusoidal stimulation was delivered synchronously and continuously on the 15 microelectrodes, or through a single macroelectrode, no effects on seizure frequency were observed. High frequency stimulation (>16.66 Hz/per electrode), in contrast, had a tendency to increase seizure frequency. These results indicate that DMM could be a new effective approach to therapeutic brain stimulation for reducing seizures in epilepsy.

Propofol differentially inhibits the release of glutamate, γ-aminobutyric acid and glycine in the spinal dorsal horn of rats.

Propofol (2, 6-diisopropylphenol) is an intravenous anesthetic that is commonly used for the general anesthesia. It is well known that the spinal cord is one of the working targets of general anesthesia including propofol. However, there is a lack of investigation of the effects of propofol on spinal dorsal horn which is important for the sensory transmission of nociceptive signals. The objective of this study was to investigate the effects of increasing dosage of propofol on the release of glutamate (Glu), γ-aminobutyric acid (GABA) and glycine (Gly) in the spinal dorsal horn. The efflux of Glu, GABA or Gly in the spinal dorsal horn of rats was detected using transverse spinal microdialysis under an awake condition and various depths of propofol anesthesia. The infusion rates of propofol were, in order, 400 µg/(kg·min), 600 µg/(kg·min) and 800 µg/(kg·min), with a 20 min infusion period being maintained at each infusion rate. Propofol decreased the glutamate efflux within spinal dorsal horn in a dose-dependent manner, and the maximum decrease was 56.8 ± 6.0% at high-dose propofol infusion producing immobility. The inhibitory GABA and Gly efflux was also decreased about 15-20% at low-dose propofol infusion only producing sedation, but did not continue to drop with higher doses of propofol. Propofol decreased both excitatory and inhibitory amino acids efflux in spinal dorsal horn, and the preferential suppression of the excitatory amino acid might be associated with the analgesic effect of propofol.

The use of the Airtraq® in Awake Tracheal Intubation: A Case Series

Objective To report the clinical experience in using the Airtraq® in awake tracheal intubation in patients with known or potential difficult airway, or unstable cervical spine. Methods Case series study. Twenty patients with known or potential difficult airway, or unstable cervical spine who underwent elective operations and might require awake fibreoptic intubation were recruited. After standardised topical anaesthesia of the airway, awake intubation was performed using the Airtraq®. The duration of the intubation procedure, the intubation difficulty scale (IDS), the rate of successful placement of endotracheal tube and patient's satisfaction were recorded. Results Fifteen out of the twenty patients were successfully intubated with the Airtraq® under awake condition leading to an overall success rate of 75%. Eleven of them were intubated in the first attempt. The mean duration of intubation was 1 min 33 s. Concerning the degree of difficulty of intubation using the Airtraq®, as evaluated with the IDS, 20% was ranked as easy and 80% was slightly difficult. Excessive secretion, patient gagging, inability to cooperate and inadequate view of larynx were the major reasons of failed intubation. Eighty percent of the patients considered the intubating procedure with the Airtraq® under awake condition acceptable. In general, patients felt mild pain and discomfort and were satisfied with the intubation process. Conclusion Airtraq® may be a useful alternative of flexible bronchoscope for awake intubation with low rate of minor complications in the elective operation setting. (Hong Kong j.emerg.med. 2015;22:248-255)

Layer-Specific Manganese-Enhanced MRI of the Diabetic Rat Retina in Light and Dark Adaptation at 11.7 Tesla.

To employ high-resolution manganese-enhanced MRI (MEMRI) to study abnormal calcium activity in different cell layers in streptozotocin-induced diabetic rat retinas, and to determine whether MEMRI detects changes at earlier time points than previously reported. Sprague-Dawley rats were studied 14 days (n = 8) and 30 days (n = 5) after streptozotocin (STZ) or vehicle (n = 7) injection. Manganese-enhanced MRI at 20 × 20 × 700 μm, in which contrast is based on manganese as a calcium analogue and an MRI contrast agent, was obtained in light and dark adaptation of the retina in the same animals in which one eye was covered and the fellow eye was not. The MEMRI activity encoding of the light and dark adaptation was achieved in awake conditions and imaged under anesthesia. Manganese-enhanced MRI showed three layers, corresponding to the inner retina, outer retina, and the choroid. In normal animals, the outer retina showed higher MEMRI activity in dark compared to light; the inner retina displayed lower activity in dark compared to light; and the choroid showed no difference in activity. Manganese-enhanced MRI activity changed as early as 14 days after hyperglycemia and decreased with duration of hyperglycemia in the outer retina in dark relative to light adaptation. The choroid also had altered MEMRI activity at 14 days, which returned to normal by 30 days. No differences in MEMRI activity were detected in the inner retina. Manganese-enhanced MRI detects progressive reduction in calcium activity with duration of hyperglycemia in the outer retina as early as 14 days after hyperglycemia, earlier than any other time point reported in the literature.

Sleep deprivation impairs inhibitory control during wakefulness in adult sleepwalkers.

Sleepwalkers often complain of excessive daytime somnolence. Although excessive daytime somnolence has been associated with cognitive impairment in several sleep disorders, very few data exist concerning sleepwalking. This study aimed to investigate daytime cognitive functioning in adults diagnosed with idiopathic sleepwalking. Fifteen sleepwalkers and 15 matched controls were administered the Continuous Performance Test and Stroop Colour-Word Test in the morning after an overnight polysomnographic assessment. Participants were tested a week later on the same neuropsychological battery, but after 25 h of sleep deprivation, a procedure known to precipitate sleepwalking episodes during subsequent recovery sleep. There were no significant differences between sleepwalkers and controls on any of the cognitive tests administered under normal waking conditions. Testing following sleep deprivation revealed significant impairment in sleepwalkers' executive functions related to inhibitory control, as they made more errors than controls on the Stroop Colour-Word Test and more commission errors on the Continuous Performance Test. Sleepwalkers' scores on measures of executive functions were not associated with self-reported sleepiness or indices of sleep fragmentation from baseline polysomnographic recordings. The results support the idea that sleepwalking involves daytime consequences and suggest that these may also include cognitive impairments in the form of disrupted inhibitory control following sleep deprivation. These disruptions may represent a daytime expression of sleepwalking's pathophysiological mechanisms.

Explicit and implicit memory during sleep

The purpose of this study was to indicate the changes in the implicit and explicit memory under awake and sleep conditions by using a battery that can measure different subsections of memory. 24 healthy individuals participated in this study. Modified versions of the Auditory Verbal Learning Test and the Modified Word Stem Completion Test were applied to the study and control groups within the scope of Modified Multiple Block Design (MMBD). While the control group did not listen to any words during sleep, the study group listened to the list of selected words. The originality of this research is the generated meaningless words given during sleep by using Mongolian language. While asking the words taught before sleep, both groups had a similar rate for remembering after sleep. The study group that was given the words during sleep had relatively higher scores for correct completions than the control group that was not given any words during sleep. The difference in correct completions of meaningless words in the Mongolian language was found to be statistically significant in the evaluation of the implicit memory. Also, there was a significant difference between the study and control groups for the implicit memory. There is a positive effect on implicit memory processes during sleep. Thus, learning can occur during sleep. Moreover, the generated MMBD enabled evaluation of both the implicit and explicit memory and also MMBD can also be useful for various consciousness states.

Pain modulation in waking and hypnosis in women: event-related potentials and sources of cortical activity.

Using a strict subject selection procedure, we tested in High and Low Hypnotizable subjects (HHs and LHs) whether treatments of hypoalgesia and hyperalgesia, as compared to a relaxation-control, differentially affected subjective pain ratings and somatosensory event-related potentials (SERPs) during painful electric stimulation. Treatments were administered in waking and hypnosis conditions. LHs showed little differentiation in pain and distress ratings between hypoalgesia and hyperalgesia treatments, whereas HHs showed a greater spread in the instructed direction. HHs had larger prefrontal N140 and P200 waves of the SERPs during hypnotic hyperalgesia as compared to relaxation-control treatment. Importantly, HHs showed significant smaller frontocentral N140 and frontotemporal P200 waves during hypnotic hypoalgesia. LHs did not show significant differences for these SERP waves among treatments in both waking and hypnosis conditions. Source localization (sLORETA) method revealed significant activations of the bilateral primary somatosensory (BA3), middle frontal gyrus (BA6) and anterior cingulate cortices (BA24). Activity of these contralateral regions significantly correlated with subjective numerical pain scores for control treatment in waking condition. Moreover, multivariate regression analyses distinguished the contralateral BA3 as the only region reflecting a stable pattern of pain coding changes across all treatments in waking and hypnosis conditions. More direct testing showed that hypnosis reduced the strength of the association of pain modulation and brain activity changes at BA3. sLORETA in HHs revealed, for the N140 wave, that during hypnotic hyperalgesia, there was an increased activity within medial, supramarginal and superior frontal gyri, and cingulated gyrus (BA32), while for the P200 wave, activity was increased in the superior (BA22), middle (BA37), inferior temporal (BA19) gyri and superior parietal lobule (BA7). Hypnotic hypoalgesia in HHs, for N140 wave, showed reduced activity within medial and superior frontal gyri (BA9,8), paraippocampal gyrus (BA34), and postcentral gyrus (BA1), while for the P200, activity was reduced within middle and superior frontal gyri (BA9 and BA10), anterior cingulate (BA33), cuneus (BA19) and sub-lobar insula (BA13). These findings demonstrate that hypnotic suggestions can exert a top-down modulatory effect on attention/preconscious brain processes involved in pain perception.

Offshore wind farm flow measured by complementary remote sensing techniques: radar satellite TerraSAR-X and lidar windscanners

Scanning Doppler lidar systems offer continuous wind measurements with some kilometres of range and a spatial distribution of concurrent measurements down to some metres. The synthetic aperture radar (SAR) satellite TerraSAR-X is capable to cover offshore areas of hundreds of square kilometres and to obtain wind data spatially distributed with some tens of metres. Images can be taken up to twice a day when the satellite passes the measurement site.Simultaneous wind speed measurements with ground based scanning Doppler lidar and TerraSAR-X in the region of the offshore wind farm ”alpha ventus” in the German North Sea were collected. A comparison of both systems in free stream conditions is performed by extrapolating the lidardata to the measurement height of the radar satellite assuming a logarithmic wind profile. In wake conditions the wake tracks obtained by lidar and TerraSAR-X are compared. In free stream conditions the comparison reveals a mean absolute wind velocity difference ≤ 0.4 m/s in two of the four considered cases and 1.1 m/s in one case. The fourth case shows a bad agreement due to a unusually low radar backscatter in the satellite's measurement. In wake conditions the wind turbine wakes could be tracked in the lidar and the satellite data. The comparison for the considered case reveals similar wake tracks in principle, but no matching due to the time difference of the measurements and the lower spatial resolution of the radar measurements.

Does Methylphenidate Affect Cystometric Parameters in Spontaneously Hypertensive Rats?

Purpose:Methylphenidate (MPH) is one of the most commonly prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD). However, there is limited research on its effects on lower urinary tract function. This study investigated changes in cystometric parameters after intragastric administration of MPH in conscious spontaneously hypertensive rats (SHRs), an animal model of ADHD.Methods:Fourteen- to 16-week-old male SHRs (n=10), weighing between 280 and 315 g, were used. Three micturition cycles were recorded before administering MPH. One hour after each intragastric MPH injection, three cycles of cystometrogram were obtained in the awake condition. Various cystometric parameters were evaluated, including basal pressure (BP), maximal pressure (MP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), micturition interval (MI), and residual volume (RV). The data were analyzed using paired Student t-tests.Results:Five SHRs were each administered a dose of 3-mg/kg MPH, and the other five received a dose of 6-mg/kg MPH. BP and MP increased significantly in the rats that received the 3-mg/kg MPH injection, but not in those that received the 6-mg/kg injection. BC, MV, and MI significantly increased in the rats that received the 6-mg/kg MPH injection, but not in those that received the 3-mg/kg injection. There were no significant changes in TP after either injection.Conclusions:Significant increases in BC, MV, and MI after the 6-mg/kg MPH injection suggest that the peripheral and the central nervous systems may play important roles in bladder function in those receiving MPH for ADHD.

Instability of wind turbine wakes immersed in the atmospheric boundary layer

In this work a technique capable to investigate the near-wake stability properties of a wind turbine immersed in the atmospheric boundary layer is presented. Specifically, a 2D local spatial stability analysis is developed in order to take into account typical flow features of real operating wind turbines, such as the presence of the atmospheric boundary layer and the turbulence heterogeneity of the oncoming wind. This stability analysis can be generally applied on either experimental measurements or numerical data. In this paper it was carried out on wind tunnel experiments, for which a downscaled wind turbine is immersed in a turbulent boundary layer. Through spatial stability analysis, the dominant mode in the near wake, i.e. the most amplified one, is characterized and its frequency matches the hub-vortex instability frequency measured in the wind tunnel. As in the case of [10], where an axisymmetric wake condition was investigated, the hub-vortex instability results in a single-helical mode.

The role of sleep in motor sequence consolidation: stabilization rather than enhancement.

Sleep supports the consolidation of motor sequence memories, yet it remains unclear whether sleep stabilizes or actually enhances motor sequence performance. Here we assessed the time course of motor memory consolidation in humans, taking early boosts in performance into account and varying the time between training and sleep. Two groups of subjects, each participating in a short wake condition and a longer sleep condition, were trained on the sequential finger-tapping task in the evening and were tested (1) after wake intervals of either 30 min or 4 h and (2) after a night of sleep that ensued either 30 min or 4 h after training. The results show an early boost in performance 30 min after training and a subsequent decay across the 4 h wake interval. When sleep followed 30 min after training, post-sleep performance was stabilized at the early boost level. Sleep at 4 h after training restored performance to the early boost level, such that, 12 h after training, performance was comparable regardless of whether sleep occurred 30 min or 4 h after training. These findings indicate that sleep does not enhance but rather stabilizes motor sequence performance without producing additional gains.

A novel urodynamic model for lower urinary tract assessment in awake rats

To develop a urodynamic model incorporating external urethral sphincter (EUS) electromyography (EMG) in awake rats. Bladder catheters and EUS EMG electrodes were implanted in female Sprague Dawley rats. Assessments were performed in awake, lightly restrained rats on postoperative day 12-14. Measurements were repeated in the same rat on day 16 under urethane anaesthesia. Urodynamics and EUS EMG were performed simultaneously. In addition, serum creatinine and bladder histology was assessed. No significant differences in urodynamic parameters were found between bladder catheter only vs bladder catheter and EUS EMG electrode groups. Urethane anaesthesia evoked prominent changes in both urodynamic parameters and EUS EMG. Serum creatinine was within the normal limits in all rats. Bladder weight and bladder wall thickness were significantly increased in both the bladder catheter only and the bladder catheter and EUS EMG group compared with controls. Our novel urodynamic model allows repetitive measurements of both bladder and EUS function at different time points in the same rat under fully awake conditions and opens promising avenues to investigate lower urinary tract dysfunction in a translational approach.

Sleep protects memories from interference in older adults

In a recent study, we demonstrated that sleep-dependent consolidation of declarative memories is preserved in older adults. The present study examined whether this benefit of sleep for declarative learning in older adults reflects a passive role of sleep in protecting memories from decay or an active role in stabilizing them. Young and older adults learned a visuospatial task, and recall was probed after sleep or wake. Although a reduction in performance was observed after sleep and wake, task-related interference before recall had a larger detriment on performance in the wake condition. This was true for young and high performing older adults only. Low performing older adults did not receive a benefit of sleep on the visuospatial task. Performance changes were associated with early night nonrapid eye movement sleep in young adults and with early night rapid eye movement sleep in high performing older adults. These results demonstrate that performance benefits from sleep in older adults as a result of an active memory stabilization process; importantly, the extent of this benefit of sleep is closely linked to the level of initial acquisition of the episodic information in older adults.

Impairment of sleep-related memory consolidation in schizophrenia: relevance of sleep spindles?

ObjectivesDeficits in declarative memory performance are among the most severe neuropsychological impairments in schizophrenia and contribute to poor clinical outcomes. The importance of sleep for brain plasticity and memory consolidation is widely accepted, and sleep spindles seem to play an important role in these processes. The aim of this study was to test the associations of sleep spindles and picture memory consolidation in patients with schizophrenia and healthy controls. MethodsWe studied 16 patients with schizophrenia on stable antipsychotic medication (mean age ± standard deviation, 29.4 ± 6.4 years) and 16 healthy controls matched for age and educational level. Sleep was recorded and scored according to American Academy of Sleep Medicine (AASM) standard criteria. We performed a picture recognition paradigm and compared recognition performance for neutral and emotional pictures in sleep and wake conditions. ResultsRecognition accuracy was better in healthy controls than in patients with schizophrenia in the sleep and wake conditions. However, the memory-promoting effect of sleep was significantly lower in schizophrenia patients than in controls. Sleep spindle activity was reduced in patients, and sleep spindle density was correlated with sleep-associated facilitation of recognition accuracy for neutral pictures. ConclusionReduced sleep spindles seem to play an important role as a possible mechanism or biomarker for impaired sleep-related memory consolidation in patients with schizophrenia, and are a new target for treatment to improve memory functions and clinical outcomes in these patients.

Effects of anesthesia on conventional and speckle tracking echocardiographic parameters in a mouse model of pressure overload.

Genetically-modified mice are widely applied in cardiovascular studies as model organisms. Echocardiography is a key tool for evaluating cardiac and hemodynamic functions in mice. The present study aimed to examine the effects of isoflurane (ISF) on conventional and speckle tracking echocardiography (STE) parameters under healthy and pathological conditions using a murine model of pressure overload. In addition, the optimal dose of ISF in the process of echocardiographic measurement, with minimum cardiac contraction depression, was investigated. Conventional echocardiographic and STE examinations were performed on 38 adult C57BL/6 male mice. The mice were divided into the following three groups: The sham (n=15); mild thoracic aortic banding (TAB; n=15); and severe TAB (n=8) groups. ISF was administered under deep anesthesia (DA; 1-2% ISF), light anesthesia (LA; 0.5-1% ISF) and immediately prior to the mice waking up (awake; 0-0.5% ISF). Conventional echocardiographic parameters were preserved within the sham and mild TAB groups (P>0.05 for each parameter) under LA and awake conditions. However, under DA conditions, the majority of these parameters were reduced compared with the LA and awake conditions (P<0.05). In the severe TAB group, conventional echocardiographic parameters remained constant under LA, DA and awake conditions. STE parameters in the groups remained similar between the LA and awake conditions, but were significantly reduced under DA conditions. Therefore, conventional echocardiography and STE may be performed using LA induced with low doses of ISF, under various pathological conditions without affecting cardiac function.

Broadcasting of cortical activity to the olfactory bulb.

Odor representations are initially formed in the olfactory bulb, which contains a topographic glomerular map of odor molecular features. The bulb transmits sensory information directly to piriform cortex, where it is encoded by distributed ensembles of pyramidal cells without spatial order. Intriguingly, piriform cortex pyramidal cells project back to the bulb, but the information contained in this feedback projection is unknown. Here, we use imaging in awake mice to directly monitor activity in the presynaptic boutons of cortical feedback fibers. We show that the cortex provides the bulb with a rich array of information for any individual odor and that cortical feedback isdependent on brain state. In contrast to the stereotyped, spatial arrangement of olfactory bulb glomeruli, cortical inputs tuned to different odors commingle and indiscriminately target individual glomerular channels. Thus, the cortex modulates early odor representations by broadcasting sensory information diffusely onto spatially ordered bulbar circuits.

Intraoperative Motor Symptoms during Brain Tumor Resection in the Supplementary Motor Area (SMA) without Positive Mapping during Awake Surgery.

Awake surgery could be a useful modality for lesions locating in close proximity to the eloquent areas including primary motor cortex and pyramidal tract. In case with supplementary motor area (SMA) lesion, we often encounter with intraoperative motor symptoms during awake surgery even in area without positive mapping. Although the usual recovery of the SMA syndrome has been well documented, rare cases with permanent deficits could be encountered in the clinical setting. It has been difficult to evaluate during surgery whether the intraoperative motor symptoms lead to postoperative permanent deficits. The purpose of this study was to demonstrate the intraoperative motor symptoms could be reversible, further to provide useful information for making decision to continue surgical procedure of tumor resection. Eight consecutive patients (from July 2012 to June 2014, six men and two women, aged 33–63 years) with neoplastic lesions around the SMA underwent an awake surgery. Using a retrospective analysis of intraoperative video records, intraoperative motor symptoms during tumor resection were investigated. In continuous functional monitoring during resection of SMA tumor under awake conditions, the following motor symptoms were observed during resection of the region without positive mapping: delayed motor weakness, delay of movement initiation, slowness of movement, difficulty in dual task response, and coordination disturbance. In seven patients hemiparesis observed immediately after surgery recovered to preoperative level within 6 weeks. During awake surgery for SMA tumors, the above-mentioned motor symptoms could occur in area without positive mapping and might be predictors for reversible SMA syndrome.