Biomedical subjects

J G Colebatch

Publications and source records attributed to J G Colebatch.

At least 37 records · Page 2Linked to original sources

PubMed1999

Resetting voluntary movement using peripheral nerve stimulation: influence of loading conditions and relative effectiveness.

The effect of peripheral nerve stimulation on voluntary rhythmic flexion-extension movements at the wrist was studied in nine normal volunteers, and the results compared with the effect of cortical stimulation on the same task. In the first part of the study, magnetic stimulation was given over the inner aspect of the right arm at levels which, at rest, resulted in a wrist flexion twitch of at least 10 degrees. We were able to confirm that this form of (peripheral-nerve) stimulation is an effective means of phase-resetting voluntary wrist movements. In addition, and unlike magnetic stimulation applied over the contralateral motor cortex, changes in the standing torque load, against which the subjects moved, had little influence on the effectiveness of this form of stimulation. Similarly, the amplitude and direction of the averaged first post-stimulus position peak ("P1"), previously identified as important determinants of the resetting induced by a cortical stimulus, were largely independent of the loading torque. In a second part to the study, we directly compared, for a constant loading torque, the resetting induced by magnetic cortical stimulation with that following magnetic stimulation of peripheral nerves. The relationship between the amplitude of P1 and the associated resetting index was identical for both forms of stimulation. Our observations indicate that magnetic stimulation of peripheral nerves is an effective means of resetting voluntary movement. It differs from magnetic cortical stimulation in that the effects of peripheral nerve stimulation are little altered by changes in loading torque. When differences in the size of P1 are allowed for, both peripheral nerve and cortical stimulation are equally effective means of resetting voluntary rhythmical movement.

Adult↗

PubMed1998

Vestibulocollic reflexes evoked by short-duration galvanic stimulation in man.

1. Vestibular-dependent responses in leg muscles following transmastoid galvanic stimulation have been well characterized. Here we describe the properties of vestibulocollic responses evoked by transmastoid galvanic stimulation. 2. In twelve healthy human subjects we examined the averaged responses in unrectified sternocleidomastoid (SCM) EMG evoked by transmastoid stimulation using current pulses of 4 mA intensity and 2 ms duration. In ten subjects we also examined the effects of unilateral vestibular stimulation with the indifferent electrode at the vertex. In further experiments we studied the effects of different levels of background muscle activation, head position, current intensity and current duration. We compared these responses with click-evoked vestibulocollic responses in SCM. 3. A clearly defined biphasic response, beginning with a surface positivity, was recorded in the SCM ipsilateral to the side of cathode placement in all subjects. We refer to this as the p13/n23 [g] (galvanic) response, given the close similarity, in terms of waveform and latencies, to the previously described click-evoked p13/n23 vestibulocollic response. The amplitude of this response was linearly related to background muscle activation, current intensity and current duration, but independent of head position. Unilateral galvanic stimulation revealed the p13/n23 [g] response to be solely generated by the cathode. 4. A biphasic response beginning with a surface negativity (n12/p20 [g]) contralateral to the cathode was seen in all subjects and was generated by both the cathode contralaterally and the anode ipsilaterally. 5. Both the p13/n23 [g] and n12/p20 [g] potentials were abolished by selective vestibular nerve section and unaffected by severe sensorineural deafness. 6. We conclude that galvanic stimulation evokes short-latency vestibulocollic reflexes. These vestibulocollic reflexes have properties that are distinct from those described for galvanic-evoked vestibular reflexes in leg muscles, and which may be related to their differing physiological roles.

Acoustic Stimulation↗

PubMed1998

An akinetic-rigid syndrome, depression, and stereotypies in a young man.

A young man is presented who developed an akinetic-rigid syndrome shortly after a minor illness. Rituals and stereoptypies were prominent. At its most severe he was unable to feed himself. There was no response to L-dopa/cardopa treatment. A course of ECT was followed by a marked improvement in his condition. Attempts to stop ECT for more than a week have led to recurrence of his bradykinesia.

Adult↗

PubMed1998

Vestibular-evoked electromyographic responses in soleus: a comparison between click and galvanic stimulation.

The aim of this study was to demonstrate, if possible, vestibulospinal reflex responses in soleus using a stimulus known to be capable of exciting vestibular afferents, namely 100-dB (NHL) clicks. We were able to show short-latency electromyographic (EMG) responses after clicks in five of eight normal subjects, and then we compared these responses with those after transmastoid galvanic stimulation (12 normal subjects). Stimulation of the side towards which the head was rotated (i.e. the side facing backwards) with either clicks or the cathode (anode applied to the opposite side) gave an initial excitatory response in soleus, while click or cathodal stimulation of the opposite side (i.e. the side facing forwards) gave an initial inhibitory response. Onset latencies and modulation with changes in postural task were identical for both click- and galvanic-evoked responses. In addition, there was a significant correlation between the amplitudes of the responses in soleus after click and galvanic stimulation (R2=0.72). These similarities suggest that the earliest reflex responses in soleus after clicks and galvanic stimulation may be mediated by a common central pathway. In contrast, there was no correlation between the amplitudes of responses evoked by 100-dB clicks in soleus and those evoked by the same stimulus in the sternocleidomastoid. We conclude that vestibular activation by clicks can evoke reflex responses in lower-limb muscles and these responses have similar characteristics to the earliest responses evoked by galvanic vestibular stimulation.

Acoustic Stimulation↗

PubMed1998

Maintained ocular torsion produced by bilateral and unilateral galvanic (DC) vestibular stimulation in humans.

This study was designed to measure ocular movements evoked by galvanic (DC) stimulation using computerised video-oculography. Long duration (>30 s) galvanic vestibular stimulation at currents of up to 5 mA through large-area surface electrodes over the mastoid processes causes maintained changes in the ocular torsional position of both eyes in healthy human subjects. With the subject seated and the head held firmly, torsion was measured by a computer-based image-processing system (VTM). Torsion was recorded in darkness, with or without a single fixation point. With bilateral stimulation, the upper poles of both eyes always torted away from the side of cathode placement and toward the anode. For unilateral stimulation, torsion was directed away from the cathode or toward the anode. The magnitude of ocular torsion was dependent on current strength: with bilateral stimulation the peak torsion was on average 2.88 degrees for 5-mA current intensity compared with 1.58 degrees for 3 mA. A smaller amplitude of torsion was obtained for unilateral stimulation. The average peak torsion was the same for both eyes for all forms of stimulation. Our findings indicate that low-intensity galvanic stimulation evokes ocular torsion in normal subjects, an effect which is consistent with an action on otolith afferents.

Adult↗

PubMed1998

Galvanic stimulation evokes short-latency EMG responses in sternocleidomastoid which are abolished by selective vestibular nerve section.

OBJECTIVE: To describe vestibulocollic responses in sternocleidomastoid (SCM) evoked by transmastoid galvanic (DC) stimulation. METHODS: We studied the averaged responses in the unrectified EMG of SCM to transmastoid galvanic stimulation (5 mA/2 ms) and also to 100 dB clicks. Two patients with Meniere's disease were studied both before and after unilateral selective vestibular nerve section. RESULTS: Transmastoid galvanic stimulation produced a positive-negative biphasic EMG response at short latency in the SCM ipsilateral to the side of cathode placement, which resembled that which followed vestibular activation by loud clicks (p13/n23). Selective unilateral vestibular nerve section abolished this galvanic-evoked response. CONCLUSIONS: Galvanic-evoked vestibulocollic responses can be recorded in SCM. This is a new method of studying vestibular reflex function which may have application in the clinical assessment of vestibular disorders.

Adult↗

PubMed1998

Vestibular hypersensitivity to clicks is characteristic of the Tullio phenomenon.

OBJECTIVES: The frequency of pathologically reduced click thresholds for vestibular activation was explored in patients with the Tullio phenomenon (sound induced vestibular activation). METHODS: Seven patients (eight affected ears) with symptoms of oscillopsia and unsteadiness in response to loud external sounds or to the patient's own voice were examined. In all but one patient, vestibular hypersensitivity to sound was confirmed by the fact that eye movements could be produced by pure tones of 110 dB intensity or less. Conventional diagnostic imaging was normal in all cases and three of the patients had normal middle ears at surgical exploration. Thresholds for click evoked vestibulocollic reflexes were compared with those of a group of normal subjects. Galvanic stimulation was used as a complementary method of examining the excitability of vestibular reflexes. RESULTS: All the patients showed a reduced threshold for click activation of vestibulocollic reflexes arising from the affected ear. Short latency EMG responses to clicks were also present in posterior neck and leg muscles, suggesting that these muscles receive vestibular projections. Galvanic stimulation produced a normal pattern of body sway in four of the five patients tested. CONCLUSIONS: A pathologically reduced threshold to click activation (< or = 70 dB NHL (average normal hearing level)) seems to be a consistent feature of the Tullio phenomenon and a useful diagnostic criterion. This in turn is most likely to be due to an increased effectiveness of the transmission of sound energy to saccular receptors. Activation of these receptors probably contributed to the vestibular symptoms experienced by the patients.

Acoustic Stimulation↗

PubMed1997

The influence of peripheral load on resetting voluntary movement by cortical stimulation: importance of the induced twitch.

We studied the effects of changes in loading torque on the effectiveness of magnetic cortical stimulation in evoking phase resetting of voluntary wrist movement. Nine normal subjects were studied (five on two occasions), while making rhythmical movements of the right wrist, at their preferred rate, against extension torque loads of 0.35 Nm, 0.26 Nm and 0.18 Nm, flexion torque loads of 0.09 Nm and 0.18 Nm and without external load. The position records of individual trials were used to measure the effectiveness of resetting (resetting index: the slope of the phase-response curve) and the "null phase", the phase to which the trials were being reset. The loading torque had a strong influence upon both the resetting index and the null phase, generated by a constant intensity of cortical stimulation such that the largest resetting indices were obtained for movements made against the largest extension torque load (mean resetting index 0.72). The degree of resetting and null phase were related to the mean amplitude and direction of the first poststimulus position peak, which in turn was largely determined by the twitch induced by the cortical shock. The timings of the averaged poststimulus position peaks following the first were simple multiples of the prestimulus movement period. Our results indicate that loading conditions profoundly influence the effectiveness of magnetic cortical stimulation in resetting a voluntary movement and that these effects appear to be largely explicable by the changes in the muscle twitch evoked by the stimulus with the different loads. We suggest that the magnetic shock is therefore unlikely to reset voluntary movement by an action directly upon the motor programme. We propose that the main method by which magnetic cortical stimulation resets repetitive wrist movement is indirect: normal generation of repetitive wrist flexion and extension is disrupted by the cortical shock, following which afferent information related to the twitch induced is able to reset the movement.

Adult↗

PubMed1997

EMG responses in the soleus muscles evoked by unipolar galvanic vestibular stimulation.

This study compared the effects of transmastoid galvanic stimulation with unilateral galvanic stimulation of vestibular afferents. We recorded the effects on soleus EMG occurring at short (SL) and medium (ML) latency, both in normal subjects and in patients with previous unilateral vestibular neurectomy. Unipolar cathodal and anodal stimulation on the same side produced opposite effects for both SL and ML responses. Responses to unilateral cathodal or anodal stimulation were smaller, but otherwise resembled those of transmastoid stimulation with the cathode or the anode placed on the same side, respectively. Unilateral cathodal stimulation resulted in a larger SL response, which occurred at shorter latency than unilateral anodal stimulation. With unipolar stimulation on the side of previous vestibular nerve section, typical SL and ML responses were absent. With stimulation of the intact side, the patients showed smaller SL responses than normal subjects with unilateral stimulation. The larger responses to unilateral cathodal compared to unilateral anodal stimulation are consistent with previous reports that cathodal stimulation produces an increase and anodal a decrease in vestibular nerve firing. The smaller SL responses in the patients may be a consequence of central nervous system reorganization following unilateral vestibular nerve section.

Adult↗

PubMed1996

Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement?

BACKGROUND: Benign paroxysmal positioning vertigo (BPPV) is generally thought to be caused by canalolithiasis in the posterior semicircular canal, an organ that is innervated by the inferior vestibular nerve. We hypothesized that absent vestibular evoked myogenic potentials (VEMPs) would indicate involvement of the inferior vestibular nerve and that posterior semicircular canal-type BPPV could not develop after vestibular neurolabyrinthitis (VNL) in patients with absent VEMPs. OBJECTIVE: To find out if VEMPs could be helpful in evaluating involvement of the inferior vestibular nerve in acute VNL. DESIGN: We reviewed the VEMP findings in 47 patients (34 men and 13 women) with acute VNL, 10 of whom had then developed posterior semicircular canal-type BPPV. RESULTS: While p13-n23, the first positive-negative peak of the VEMP, was ipsilaterally present on stimulation of the unaffected side in all patients, it was absent on the affected side in 16 patients (34%). The absence or presence of p13-n23 was independent of the results of caloric tests, pure tone audiometry, and auditory brain-stem responses. Typical posterior semicircular canal BPPV developed in 10 of the 47 patients after the acute attack of VNL, always on the same side as the neurolabyrinthitis. The p13-n23 potentials were preserved on stimulation of the affected ear in all 10 patients with BPPV. CONCLUSIONS: These results suggest that if VEMPs are absent from an ear that has suffered acute VNL, then posterior semicircular canal BPPV is unlikely to develop as a consequence of the VNL. The reason for this appears to be that the absence of VEMPs is due to involvement of the inferior vestibular nerve or involvement of the structures that it innervates.

Acoustic Stimulation↗

PubMed1996

Surface potentials generated by synchronous activation of different fractions of the motor pool.

Surface electromyogram potentials were recorded from the abductor pollicis brevis, abductor digiti minimi, and extensor digitorum brevis muscles in response to finely graded nerve stimuli. Successive potentials were subtracted to obtain intermediate potentials 2%, 5%, 10%, 20%, and 50% of the maximal compound muscle action potential (mCMAP). The average latency of the onset and negative and positive peaks, and the average duration of the negative phase and whole potential were similar for all degrees of fractionation, although smaller fractionation was associated with increasing variability. An initial positivity occurred with some of the smaller fractions of the CMAP, particularly those with the lowest stimulus threshold. Submaximal CMAPs closely resembled the mCMAP once their amplitude was greater than 5-10% of the mCMAP. Our results support the common practice of expressing H-reflex amplitudes as a percentage of the M wave and may partly explain why reflexes "scale" in response to tonic activation.

Action Potentials↗

PubMed1996

Voluntary rhythmical movement is reset by stimulating the motor cortex.

Using six normal subjects, we mapped the best location for magnetic cortical stimulation to "reset" the phase of a voluntary alternating movement of the right wrist made against three different torques (0.26 N m extension, 0 and 0.09 N m flexion torque) at the subjects' preferred rate. We used "nett resetting" as a measure of phase resetting, based upon the relative amplitudes of the averages of the stimulated and a phase-locked control position record. Nine sites covering a 5 cm square region of the contralateral cortex were systematically stimulated. All the subjects showed evidence of resetting in response to magnetic stimulation over one or more cortical sites during movements made against the extension torque and all subjects demonstrated higher levels of nett resetting under these conditions than in response to similar cortical stimulation during unloaded movements. The best cortical sites for inducing resetting were the same as those from which the largest short-latency responses were evoked in the contralateral forearm flexor and extensor muscles, i.e. the motor cortex. At the cortical sites where magnetic stimulation did induce resetting, the initial electromyographic (EMG) effects consisted of a short-latency excitation followed by a period of inhibition. This silent period was followed by a short burst of excitation often occurring simultaneously in the wrist flexor and extensor muscles, and only thereafter by the return of rhythmical alternating EMG activity characteristic of the wrist movement. The latency to the first rhythmical EMG peak following the stimulus was closely related to the period of the subject's prestimulus movement.

Adult↗

PubMed1996

A modified method of estimating phase resetting of rhythmical movement.

A computer-based method of estimating resetting index is presented which was successfully applied to a study of resetting of human voluntary rhythmical movement. Peaks were detected before and after the stimulus (magnetic cortical stimulation) from position records and the phase of stimulation and the phase change induced by the stimulus estimated. The phase change versus phase of stimulation relationship was rotated until the best linear fit was obtained: the gradient of this relationship is the resetting index. The calculation of resetting index was thus independent of the initial assignment of reference phase. A constant, the null phase, was derived from the best linear fit and indicates the phase to which the original waveform is being reset by the stimulus. Statistical tests of significance and linearity of the final relationship are also described.

Computers↗

PubMed1995

Click-evoked vestibulocollic reflexes in torticollis.

A total of 26 patients with torticollis were studied using a recently developed technique for recording vestibulocollic reflexes from the sternocleidomastoid muscles in addition to conventional caloric tests of vestibular function. Previous reports of abnormalities of vestibulo-ocular reflexes in these patients were confirmed with just fewer than half having significant canal pareses or directional preponderances (nine of 20 tested). In addition, there was a high incidence of abnormal click-evoked vestibulocollic reflexes (17 of 26 tested), which were not simply the result of prior treatment with botulinum toxin, nor due to unequal levels of muscle activation. In patients never previously treated with botulinum toxin (14 patients), the effect almost always consisted of suppressed responses in the sternocleidomastoid muscle ipsilateral to the direction of head turning. Because responses were not abnormal in all patients tested, and more commonly so in those with a history of torticollis of > or = 5 years (eight of nine patients) than in de novo patients, we suggest that the changes are more likely to be compensatory than causal.

Acoustic Stimulation↗

PubMed1995

Motor function in a patient with bilateral lesions of the globus pallidus.

This study describes the long-term deficits of a patient who, after a toxic encephalopathy, sustained extensive bilateral damage to both segments of the globus pallidus (GP) and the right substantia nigra (SN). There were no signs of lesions of the pyramidal tracts or of other motor structures. The most obvious deficits were an abnormal gait with an exaggerated knee extension and a tendency to fall slowly, especially when pushed backward. In contrast, Romberg's test on an unstable platform was normal, as were long-latency leg reflexes induced by perturbations. Inadequate anticipatory and compensatory postural responses, in particular across the hip and knee joints, and slow movements seemed responsible for the falls. Muscle tone was normal but reflex studies showed signs of abnormal facilitation and inhibition at various levels of the neuraxis. We conclude that the GP and SN lesions caused defective input to premotor cortical and brain stem target zones. Dysfunctioning of these zones leads to improper control of the descending ventromedial motor system responsible for locomotion, postural control, and reflex status. The deficits in upper extremity motor performance included delayed and slow movements, inaccurate amplitudes of ballistic responses, a lack of predictive control, and deficits in bimanual coordination. Sensory feedback, proprioceptive more than visual, played a powerful compensating role in rapid aiming movements. Regional blood flow (studied using 15(O)2) was reduced in multiple frontal cortical regions, among which are the hand areas of the supplementary and premotor cortex. We hypothesize that this reflected impaired functioning of these areas, caused by defective bilateral output from GP and SN, and resulting in the motor deficits of the arm and hand.

Adult↗

PubMed1995

Responses of guinea pig primary vestibular neurons to clicks.

Responses of single neurons in the vestibular nerve to high-intensity clicks were studied by extracellular recording in anaesthetised guinea pigs. One hundred and two neurons in the posterior division of the superior branch or in the inferior branch of the vestibular nerve were activated at short latency by intense clicks. The latency of activation was short (median 0.9 ms) and the threshold was high: the click intensity for evoking the response of these cells was around 60 dB above the auditory brainstem response threshold. Animals were tilted and rotated to identify physiologically the sensory region of the labyrinth from which the activated neurons originated. Seventeen neurons responded to static tilt as well as clicks. These results show that vestibular receptors, probably the otoliths, respond to clicks at intensities corresponding to those used in a new clinical test of the vestibulo-collic pathway.

Acoustic Stimulation↗

PubMed1995

Mapping of cortical sites where transcranial magnetic stimulation results in delay of voluntary movement.

Transcranial magnetic stimulation over the motor cortex has been shown to delay voluntary movement in man in a reaction time paradigm. In this study, we used a focal magnetic coil to stimulate 16 sites over the left hemisphere in 8 normal subjects. We measured the delay that occurred in the onset of a ballistic wrist flexion response and the size of the motor potentials evoked in the wrist flexors by stimulation at each site. The optimal site of stimulation to delay voluntary movement coincided with the optimal site to elicit an MEP in the agonist (flexor) muscle. However, MEPs were also obtained from some sites at which no delay in movement was induced.

Adult↗

PubMed1995

Tapping the head activates the vestibular system: a new use for the clinical reflex hammer.

We investigated the use of skull taps with a modified clinical reflex hammer as a method of vestibular activation. Using recently described EMG techniques to measure vestibulocollic reflexes in response to clicks, we were able to show analogous short-latency potentials to taps. The earliest responses were invariably absent on the side of a previous vestibular nerve section but were preserved in profound sensorineural or conductive hearing loss. We propose that the taps activated the vestibular apparatus directly by a bone-conducted vibration wave.

Acoustic Stimulation↗