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Studies of sensory and motor cortex physiology: with observations on akinesia in Parkinson's disease.

Magnetic stimulation of the brain can be used to investigate sensory and motor physiology and pathophysiology in intact humans. Although uncommon, it is possible for magnetic stimulation over sensorimotor cortex to produce paresthesis. With magnetic stimulation, it is also possible to block the conscious sensation of an electrical shock delivered to the index finger. The magnetic stimulus must be delivered in the interval from 300 msec before to 200 msec after the cutaneous shock and must be delivered over the contralateral hand region of the sensorimotor cortex. In a reaction time situation, the expected voluntary response may be delayed by a magnetic stimulus delivered over the sensorimotor cortex just before the movement. With the use of a relatively weak magnetic stimulus that does not produce a motor evoked potential (MEP) when the body part is at rest, but that will produce a response when the body part is activated, the reaction time can be divided into two periods. In the first period, there is no MEP and the motor cortex remains 'inexcitable'. In the second period, there is a gradual increase in MEP amplitude even though the voluntary electromyographic activity has not yet appeared. This 'excitable' period indicates the activation of motor cortex before the motor command is delivered. Application of this technique to the analysis of prolonged reaction time (akinesia) in patients with Parkinson's disease shows that the excitable period is prolonged. This describes the mechanism underlying the difficulty in the generation of a motor command in these patients.

Adult↗

Improved understanding of cortical injury by incorporating measures of functional anatomy.

Volume of injury is often used to describe a brain insult. However, this approach assumes cortical equivalency and ignores the special importance that certain cortical regions have in the generation of behaviour. We hypothesized that incorporating knowledge of normal brain functional anatomy into the description of a motor cortex injury would provide an improved framework for understanding consequent behavioural effects. Anatomical scanning was performed in 21 patients with a chronic cortical stroke that involved the sensorimotor cortex. Functional MRI (fMRI) was used to generate separate average activation maps for four tasks including hand, shoulder and face motor tasks in 14 controls. For each task, group average maps for contralateral sensorimotor cortex activation were generated. Injury to these maps was measured by superimposing each patient's infarct. These measurements were then correlated with behavioural assessments. In bivariate analyses, injury to fMRI maps correlated with behavioural assessments more strongly than total infarct volume. For example, performance on the Purdue pegboard test by the stroke-affected hand correlated with the fraction of hand motor map injured (r = -0.79) more strongly than with infarct volume (r = -0.60). In multiple linear regression analyses, measures of functional map injury, but not infarct volume, remained as significant explanatory variables for behavioural assessments. Injury to >37% of the hand motor map was associated with total loss of hand motor function. Hand and shoulder motor maps showed considerable spatial overlap (63%) and similar behavioural consequences of injury to each map, while hand and face motor maps showed limited overlap (10.4%) and disparate behavioural consequences of injury to each map. Lesion effects support current models of broad, rather than focal, sensorimotor cortex somatotopic representation. In the current cross-sectional study, incorporating an understanding of normal tissue function into lesion measurement provided improved insights into the behavioural consequences of focal brain injury.

Adult↗

Anticipatory electroencephalography alpha rhythm predicts subjective perception of pain intensity.

UNLABELLED: This high-resolution electroencephalography (EEG) study tested the hypothesis that the suppression of rolandic alpha power before predictable painful stimulation affects the subject's subsequent evaluation of pain intensity, as a reflection of the influence of expectancy processes on painful stimulus processing. High-resolution EEG data were recorded (126 channels) from 10 healthy adult volunteers during the expectancy of a painful CO(2)-laser stimulation at the right wrist. Surface laplacian estimation enhanced the EEG spatial information content over 6 scalp regions of interest (left frontal, right frontal, left central, right central, left parietal, and right parietal areas). Spectral power was computed for 3 alpha sub-bands with reference to the individual alpha frequency peak (about 5-7 Hz for alpha 1, 7-9 Hz for alpha 2, and 9-11 Hz for alpha 3). The suppression of the alpha power before the painful stimulation [as reflected by the event-related desynchronization (ERD)] indexed the anticipatory cortical processes. Results showed maximum (negative) correlations between the alpha 2 and alpha 3 ERD amplitude at the left central area and the subjective evaluation of pain intensity (P < .001). The stronger the anticipatory alpha 2 and alpha 3 ERD, the higher the subjective evaluation of pain intensity. For alpha 3, that correlation was confirmed even when the effect of habituation across the recording session was taken into account. These results suggest that the anticipatory suppression of the alpha rhythms over the contralateral primary sensorimotor cortex predicts subsequent subjects' evaluation of pain intensity, in line with its crucial role for the discrimination of that intensity. PERSPECTIVE: This electroencephalographic study showed that anticipatory activation/deactivation of sensorimotor cortex roughly predicts subjective evaluation of pain. This motivates further investigation on possible implications for the understanding of central chronic pain. Chronic pain patients might exaggerate the anticipatory activation of sensorimotor cortex to negligible pain stimuli.

Adult↗

Motor-related intracortical steal phenomenon detected by multichannel functional near-infrared spectroscopy imaging.

BACKGROUND: Patients with severe cerebral ischemia may lose autoregulation to increase cerebral blood flow following neural activity. Although the steal phenomenon under conventional cerebral blood flow study has been known as a high-risk factor for stroke, the cerebral oxygen hemodynamics in ischemic patients during functional activation has not been thoroughly investigated. In this study, we present rare cases with intracortical steal phenomenon during motor tasks detected by multichannel functional near-infrared spectroscopy before and after surgery. METHODS: The relative concentration change of oxygenated, deoxygenated and total hemoglobin in and around the primary sensorimotor cortex during contralateral hand grasping was investigated in 11 patients with severe internal carotid artery stenosis. RESULTS: In 3 patients, the concentration of total hemoglobin around the primary sensorimotor cortex significantly decreased in response to motor stimulation and returned to baseline soon after termination of the motor task. This phenomenon partially disappeared postoperatively in all patients who underwent surgery. The remaining 8 patients showed no signs of total hemoglobin decrease in and around the sensorimotor cortex. In 9 patients, lack of decrease in deoxygenated hemoglobin in the center of the primary motor cortex during the motor task was observed and 3 of them showed significant increase in deoxygenated hemoglobin. CONCLUSIONS: We have demonstrated that in some patients with severe ischemia, an abnormal motor-related steal phenomenon can be observed. This phenomenon can be modulated by surgical intervention and might imply the severity of ischemia.

Aged↗

Brain motor system function after chronic, complete spinal cord injury.

Most therapies under development to restore motor function after spinal cord injury (SCI) assume intact brain motor functions. To examine this assumption, 12 patients with chronic, complete SCI and 12 controls underwent functional MRI during attempted, and during imagined, right foot movement, each at two force levels. In patients with SCI, many features of normal motor system function were preserved, however, several departures from normal were apparent: (i) volume of activation was generally much reduced, e.g. 4-8% of normal in primary sensorimotor cortex, in the setting of twice normal variance in signal change; (ii) abnormal activation patterns were present, e.g. increased pallido-thalamocortical loop activity during attempted movement and abnormal processing in primary sensorimotor cortex during imagined movement; and (iii) modulation of function with change in task or in force level did not conform to patterns seen in controls, e.g. in controls, attempted movement activated more than imagined movement did within left primary sensorimotor cortex and right dorsal cerebellum, while imagined movement activated more than attempted movement did in dorsolateral prefrontal cortex and right precentral gyrus. These modulations were absent in patients with SCI. Many features of brain motor system function during foot movement persist after chronic complete SCI. However, substantial derangements of brain activation, poor modulation of function with change in task demands and emergence of pathological brain events were present in patients. Because brain function is central to voluntary movement, interventions that aim to improve motor function after chronic SCI likely also need to attend to these abnormalities of brain function.

Adult↗

A functional MRI study of three motor tasks in the evaluation of stroke recovery.

Functional brain imaging studies have provided insights into the processes related to motor recovery after stroke. The comparative value of different motor activation tasks for probing these processes has received limited study. We hypothesized that different hand motor tasks would activate the brain differently in controls, and that this would affect control-patient comparisons. Functional magnetic resonance imaging (MRI) was used to evaluate nine control subjects and seven patients with good recovery after a left hemisphere hemiparetic stroke. The volume of activated brain in bilateral sensorimotor cortex and four other motor regions was compared during each of three tasks performed by the right hand: index-finger tapping, four-finger tapping, and squeezing. In control subjects, activation in left sensorimotor cortex was found to be significantly larger during squeezing as compared with index-finger tapping. When comparing control subjects with stroke patients, patients showed a larger volume of activation in right sensorimotor cortex during index-finger tapping but not with four-finger tapping or squeezing. In addition, patients also showed a trend toward larger activation volume than controls within left supplementary motor area during index-finger tapping but not during the other tasks. Motion artifact was more common with squeezing than with the tapping tasks. The choice of hand motor tasks used during brain mapping can influence findings in control subjects as well as the differences identified between controls and stroke patients. The results may be useful for future studies of motor recovery after stroke.

Adult↗

Somatosensory evoked magnetic fields following passive finger movement.

The somatosensory evoked magnetic field (SEF) following passive finger movement and electrical stimulation of finger was studied in 10 normal subjects. Four main components were identified in SEFs recorded at the hemisphere contralateral to the moved finger: 1M(P), 2M(P), 3M(P) and 4M(P). The 1M(P) was clearly identified only in three subjects and was smaller than other components. The equivalent current dipoles (ECDs) of 1M(P) were located around the finger area of the primary sensorimotor cortex and oriented either posteriorly or anteriorly. We speculate that it was generated in areas 3a or 2 of the primary sensory cortex. The 2M(P) and 3M(P) were usually combined as one large deflection with two peaks. Because the ECDs of 2M(P) and 3M(P) were located around the finger area of the sensorimotor cortex and both oriented posteriorly, they were considered to be generated in area 4 and/or 3b, and their activities have temporal overlapping. The 4M(P) has large inter-individual difference in terms of amplitude and latency. The ECD of 4M(P) was also located around the finger area of the primary sensorimotor cortex, and oriented anteriorly. The 4M(PI), the main component recorded from the hemisphere ipsilateral to the moved finger, was located in the upper bank of the sylvian fissure, probably the second sensory cortex (SII). Five components, 1M(E), 2M(E), 3M(E), 4M(E) and 4M(EI), corresponding to 1M(P), 2M(P), 3M(P), 4M(P) and 4M(PI), were identified following electrical stimulation of the same finger. However, SEFs following passive movement were clearly different from SEFs following electrical stimulation, in terms of waveforms and source locations, probably due to differences of ascending fibers and receptive fields.

Adult↗

Hypercapnia reversibly suppresses low-frequency fluctuations in the human motor cortex during rest using echo-planar MRI.

Using magnetic resonance (MR) echo-planar imaging (EPI), we recently demonstrated the presence of low-frequency fluctuations (< 0.1 Hz) in MR signal intensity from the resting human brain that have a high degree of temporal correlation (p < 10(-3)) within and across associated regions of the sensorimotor cortex. These fluctuations in MR signal intensity are believed to arise from fluctuations in capillary blood flow and oxygenation. A substantial overlap between the activation map generated by bilateral finger tapping and temporally-correlated voxels from the sensorimotor cortex obtained during rest was observed. In the work reported here, we investigated whether respiratory hypercapnia, which is known to suspend spontaneous oscillations in regional cerebral blood flow, influences these low-frequency fluctuations. The magnitude of low-frequency fluctuations was reversibly diminished during hypercapnia, resulting in a substantial decrease of the temporal correlation both within and across contralateral hemispheres of the sensorimotor cortex. After the breathing mixture was returned to ambient air, the magnitude and spatial extent of the temporal correlation of low-frequency fluctuations returned to normal. Results of this study support the hypothesis that low-frequency physiological fluctuations observed by MR in the human cortex and spontaneous flow oscillations observed in early studies by laser-Doppler flowmetry (LDF) in the cortex of the rat are identical and are secondary to fluctuations in neuronal activity.

Adult↗

Functional correlates of pallidal stimulation for Parkinson's disease.

We measured regional cerebral blood flow with H2 15O and positron emission tomography (PET) scanning at rest and during a motor task to study the mechanism of motor improvement induced by deep brain stimulation of the internal globus pallidus in Parkinson's disease. Six right-handed patients with Parkinson's disease were scanned while performing a predictable paced sequence of reaching movements and while observing the same screen displays and tones. PET studies were performed ON and OFF stimulation in a medication-free state. Internal globus pallidus deep brain stimulation improved off-state United Parkinson's Disease Rating Scale motor ratings (37%, p < 0.002) and reduced timing errors (movement onset time, 55%, p < 0.01) as well as spatial errors (10%, p < 0.02). Concurrent regional cerebral blood flow recordings revealed a significant enhancement of motor activation responses in the left sensorimotor cortex (Brodmann area [BA] 4), bilaterally in the supplementary motor area (BA 6), and in the right anterior cingulate cortex (BA 24/32). Significant correlations were evident between the improvement in motor performance and the regional cerebral blood flow changes mediated by stimulation. With internal globus pallidus deep brain stimulation, improved movement initiation correlated with regional cerebral blood flow increases in the left sensorimotor cortex and ventrolateral thalamus and in the contralateral cerebellum. By contrast, improved spatial accuracy correlated with regional cerebral blood flow increases in both cerebellar hemispheres and in the left sensorimotor cortex. These results suggest that internal globus pallidus deep brain stimulation may selectively improve different aspects of motor performance. Multiple, overlapping neural pathways may be modulated by this intervention.

Adult↗

Changes in rolandic mu rhythm during observation of a precision grip.

We recorded 128-channel EEG from 16 participants while they observed, imitated, and self-initiated the precision grip of a manipulandum. Mu rhythm amplitudes were significantly lower during observation of a precision grip than during observation of a simple hand extension without object interaction. Scalp topographies for subtractions of observation, imitation, and execution conditions from the control condition showed a high degree of congruence, supporting the notion of a human observation-execution matching system. Surface Laplacian transformations suggest that the decrease in mu amplitude during precision grip observation reflects desynchronization of mu rhythm generators in the sensorimotor cortex. These results support the hypothesis that sensorimotor cortex is a neural substrate involved in the representation of both self- and other-generated actions and show the mu rhythm is sensitive to subtle changes in observed motor behavior.

Adult↗

fMRI reveals two distinct cerebral networks subserving speech motor control.

BACKGROUND: There are few data on the cerebral organization of motor aspects of speech production and the pathomechanisms of dysarthric deficits subsequent to brain lesions and diseases. The authors used fMRI to further examine the neural basis of speech motor control. METHODS AND RESULTS: In eight healthy volunteers, fMRI was performed during syllable repetitions synchronized to click trains (2 to 6 Hz; vs a passive listening task). Bilateral hemodynamic responses emerged at the level of the mesiofrontal and sensorimotor cortex, putamen/pallidum, thalamus, and cerebellum (two distinct activation spots at either side). In contrast, dorsolateral premotor cortex and anterior insula showed left-sided activation. Calculation of rate/response functions revealed a negative linear relationship between repetition frequency and blood oxygen level-dependent (BOLD) signal change within the striatum, whereas both cerebellar hemispheres exhibited a step-wise increase of activation at approximately 3 Hz. Analysis of the temporal dynamics of the BOLD effect found the various cortical and subcortical brain regions engaged in speech motor control to be organized into two separate networks (medial and dorsolateral premotor cortex, anterior insula, and superior cerebellum vs sensorimotor cortex, basal ganglia, and inferior cerebellum). CONCLUSION: These data provide evidence for two levels of speech motor control bound, most presumably, to motor preparation and execution processes. They also help to explain clinical observations such as an unimpaired or even accelerated speaking rate in Parkinson disease and slowed speech tempo, which does not fall below a rate of 3 Hz, in cerebellar disorders.

Adolescent↗

Quantitation of regional cerebral blood flow increases during motor activation: a steady-state arterial spin tagging study.

Steady-state arterial spin tagging MRI approaches were used to quantitate regional cerebral blood flow increases during finger tapping tasks in seven normal subjects. Statistically significant increases in cerebral blood flow were observed in the contralateral primary sensorimotor cortex in all seven subjects and in the supplementary motor area in five subjects. The intrinsic spatial resolution of the cerebral blood flow images was approximately 4 mm. If no spatial filtering was applied, the average increase in cerebral blood flow in the activated primary sensorimotor cortex was 60 +/- 10 cc/100 g/min (91 +/- 32%). If the images were filtered to a spatial resolution of 15 mm, the average increase in cerebral blood flow in the activated primary sensorimotor cortex was 23 +/- 7 cc/100 g/min (42 +/- 15%), in agreement with previously reported 133Xe and PET results.

Adult↗

Remodelling of sensorimotor maps in paraplegia: a functional magnetic resonance imaging study after a surgical nerve transfer.

The adult mammalian brain has the capacity of reorganising its neural connections in response to lesions/modifications of the peripheral and central nervous system. We show in vivo, using functional magnetic resonance imaging (fMRI), that in paraplegics the lower-limb sensorimotor cortex is invaded by the arm representation. This functional reshaping appears to be reversible. Indeed, surgical transfer of the ulnar nerve to the ipsilateral quadriceps and hip muscles allowed their contraction in a paraplegic patient. During fMRI, these voluntary movements activated the hip and thigh representation in sensorimotor cortex. We suggest that the functional recovery of the lower-limb functional maps might have been driven by the restored somatosensory inputs from the reactivated periphery. The voluntary movements of the lower-limbs are regained through the 're-awakening' of the corresponding sensorimotor cortex.

Adult↗

Comparison between human and artificial neural network detection of Laplacian-derived electroencephalographic activity related to unilateral voluntary movements.

A back-propagation artificial neural network (ANN) was tested to verify its capacity to select different classes of single trials (STs) based on the spatial information content of electroencephalographic activity related to voluntary unilateral finger movements. The rationale was that ipsilateral and contralateral primary sensorimotor cortex can be involved in a nonstationary way in the control of unilateral voluntary movements. The movement-related potentials were surface Laplacian-transformed (SL) to reduce head volume conductor effects and to model the response of the primary sensorimotor cortex. The ANN sampled the SL from four or two central channels overlying the primary motor area of both sides in the period of 80 ms preceding the electromyographic response onset in the active muscle. The performance of the ANN was evaluated statistically by calculating the percentage value of agreement between the STs classified by the ANN and those of two investigators (used as a reference). The results showed that both investigator and ANN were capable of selecting STs with the SL maximum in the central area contralateral to the movement (contralateral STs, about 25%), STs with considerable SL values also in the ipsilateral central area (bilateral STs, about 50%), and STs with neither the contralateral nor bilateral pattern ("spatially incoherent" single trials; about 25%). The maximum agreement (64-84%) between the ANN and the investigator was obtained when the ANN used four spatial inputs (P < 0.0000001). Importantly, the common means of all single trials showed a weak or absent ipsilateral response. These results may suggest that a back-propagation ANN could select EEG single trials showing stationary and nonstationary responses of the primary sensorimotor cortex, based on the same spatial criteria as the experimenter.

Electroencephalography↗

Somatosensory evoked magnetic fields: relation to pre-stimulus mu rhythm.

OBJECTIVES: Brain responses to auditory and visual stimuli have been previously shown to depend on the level of spontaneous brain activity in the 8-13 Hz range. Our aim was to determine whether somatosensory evoked responses are influenced by ongoing rhythmic activity in the 8-13 Hz frequency range originating in the sensorimotor cortex (mu rhythm). METHODS: We used a whole-head 122 channel magnetoencephalography (MEG) system to record somatosensory evoked fields (SEFs) in response to median nerve stimulation in 11 subjects. Spontaneous oscillations in the 8-13 Hz band over the contralateral sensorimotor cortex were evaluated in 3 different pre-stimulus time intervals using wavelet analysis. RESULTS: The N20m SEF deflection did not depend on pre-stimulus activity, while the amplitude of the P35m deflection, and to a lesser extent that of the P60m deflection, showed a small positive correlation with the amplitude of the pre-stimulus mu rhythm. Although the amplitude of the mu rhythm varied by a factor of 2.3-5, the maximum variations in P35m and P60m amplitude were only 21 and 12%, respectively. The latencies of the peaks were not affected by the strength of the pre-stimulus mu rhythm. CONCLUSIONS: It appears that the first excitatory cortical response (N20m) is independent of the oscillatory state (8-13 Hz frequency range) of the sensorimotor cortex. Later parts of the response (P35m and P60m) are also relatively stable compared with the large variations in mu rhythm.

Adult↗

Axonal damage associated with enlargement of ventricles during hydrocephalus: a silver impregnation study.

Motor and cognitive deficits are commonly associated with hydrocephalus. Although the mechanisms responsible for these impairments have not been confirmed, neuronal cell death and axon degeneration may play an important role, and have long lasting consequences on neuronal connectivity. The goal of this study was to determine if neural degeneration occurred during hydrocephalus in structures anatomically related to cognitive motor functioning, namely, the sensorimotor cortex, neostriatum, hippocampus and corpus callosum. Neural damage, as visualized by silver staining, was examined in adult rats 2-10 weeks after obstructive hydrocephalus was induced by kaolin injection into the cisterna magna. In mild or moderate hydrocephalus, mostly occurring 2-6 weeks after kaolin injections, silver-labeled axons were scattered in the white matter of the sensorimotor cortex, corpus callosum, neostriatum, and hippocampus. In severe hydrocephalus, 10 weeks after kaolin injections, axon degeneration was more extensive in these areas, as well as in layers IV through VI of the sensorimotor cortex. Axons in the subiculum and the fimbria were heavily labeled, suggesting damage to hippocampal afferent and efferent fibers. In contrast, neuron cell death was rarely observed at any stage of hydrocephalus. The major pathological change of brain regions involved in motor and learning functions during hydrocephalus is axon degeneration, and this degeneration is correlated with an enlargement of the cerebral ventricles.

Animals↗

[Morphophysiologic study of reticulo-cortical pathways in the rabbit].

The character of functional connections between the midbrain reticular formation (RF) and the neocortex was studied in rabbits. Unit activity was recorded in sensorimotor cortex by extracellular microelectrode during RF stimulation. Short-latency neuronal reactions were found presumably identified as monosynaptic responses. Results of the studies of anterograde degeneration of myelinic fibers and axonal terminals after electrocoagulation of the RF carried out with the help of electronic microscope allowed to suppose that there were few (less than 0.5 per cent) monosynaptic connections between the RF and the sensorimotor cortex. The main forms of direct connections between these structures were axo-dendritic (situated at the dendritic trunk) and axosomatic synapses at the neurones of the sensorimotor cortex.

Animals↗

Regional Forebrain Noradrenalin Release in Response to Focal and Generalized Seizures Induced by Hippocampal Kindling Stimulation.

In vivo microdialysis was used to monitor noradrenalin (NA) release in the rat hippocampus, sensorimotor cortex and amygdala in response to seizures induced by electrical kindling stimulation in the hippocampus. Generalized seizures increased NA output in the hippocampus five-fold above baseline level (as assessed with 2-min sampling periods). The peak value was seen 2 - 4 min after onset of seizure activity and baseline was reached after another 6 - 8 min. In the sensorimotor cortex, there was a seven-fold increase showing a similar time-course. Focal hippocampal seizures gave rise to three-fold and 80% increases above baseline in the hippocampus and sensorimotor cortex, respectively. A unilateral knife transection of the dorsal noradrenergic bundle reduced hippocampal NA release induced by focal seizures by 53%. In animals subjected to 30 stimulus-evoked seizures with 5-min intervals ('rapid kindling'), maximal NA output was observed after the third seizure in both hippocampus (237% increase) and amygdala (122% increase). NA levels tapered off with repeated stimulation and reached baseline after nine stimulations in the hippocampus; in the amygdala, the NA output was still slightly elevated at the end of the stimulation period. These results indicate that there is a general activation of the locus coeruleus system during focal as well as generalized seizures, as evidenced by marked increases in transmitter release from noradrenergic terminals in all forebrain areas studied. NA output in areas exhibiting seizure activity is dependent on impulse flow in locus coeruleus neurons and probably also on local regulatory mechanisms active at the noradrenergic terminal level. The increase in inhibitory noradrenergic transmission in both epileptic and non-epileptic brain regions may dampen ongoing seizure activity as well as lessen its spread and generalization.

Journal Article↗