Properties of rat cone-mediated electroretinograms during light adaptation

PURPOSE

Our aim was to better understand how to isolate the cone-mediated response in rats. Therefore, we studied the difference of ERGs in the course of light adaptation between 2 and 20 Hz stimulus frequencies.

METHODS

A total of 90 rats divided into 18 different groups were used following overnight dark adaptation. ERGs were recorded against 3 different adapting field luminances (1.15, 1. 50 or 1.75 log cd/m(2)) with a combination of 3 stimulus flash intensities (0.86, 1.30 or 2.03 log cd sec/m( 2)). The responses were obtained at 2 minute intervals for 25 minutes of light adaptation.

RESULTS

The response of the rat cone ERG was large despite the small number of cones. The mean amplitude increased systematically from the dark-adapted value requiring more than 15 minutes to reach an asymptote at 2 Hz stimulation, but only 10 minutes at 20 Hz stimulation. The 2 Hz adaptation curves had biphasic pattern compared to the monophasic 20 Hz curve. This second increase in the amplitude at 2 Hz appeared at around 7-8 minutes as a function of adaptation time. This tendency was most evident when using a low adapting field luminance with a high flash intensity.

CONCLUSIONS

Our results suggest that the rods intrude much more during light adaptation at 2 Hz stimulation in rodents than in humans. Therefore, 20 Hz flicker stimulation can better isolate more the cone-mediated function than 2 Hz stimulation during the course of light adaptation in rats. Furthermore, the functional characteristics of the cone in rats may be different from that in humans.

Motor and somatosensory evoked potential findings in HTLV-I associated myelopathy

The central motor and sensory conduction times were measured using the motor and somatosensory evoked potentials in 21 patients with HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) to evaluate the functions of the corticospinal tract and posterior column. The control subjects were closely matched for gender, age and height with the patients in the central sensory conduction time (CSCT) and central motor conduction time (CMCT) studies. An abnormal upper limb (UL) CMCT was present in six of 34 limbs (17.6%) while the lower limb (LL) CMCT was abnormal in 31 of 42 limbs (73.8%). No patients had an abnormal UL CSCT while the LL CSCT was abnormal in 10 of 32 limbs (31.3%). The frequency of abnormal LL CMCT was significantly higher than that for an abnormal LL CSCT. The duration of the disease and the disability score did not significantly influence the evoked potential findings. These results indicate that major lesions of the spinal cord in HAM/TSP patients tend to be localized more in the descending corticospinal pathways than in the ascending posterior columns at the thoracic spinal cord level. This finding also closely agrees with the clinico-pathological findings of HAM/TSP.

Parvocellular and magnocellular visual processing in spinocerebellar degeneration and Parkinson's disease: an event-related potential study

OBJECTIVE

We recorded event-related potentials (ERPs) using appropriate visual stimuli to establish a non-invasive method that separately investigates the parvocellular (P) and magnocellular (M) visual functions, and to evaluate the visual function in spinocerebellar degeneration (SCD) and Parkinson's disease (PD).

METHODS

Eight SCD and 10 PD patients were compared with 11 age-matched control subjects. In the P-task, subjects were required to discriminate equiluminant red (frequent) and green (rare) random dots. In the M-task, moving random dots on a rotating cylinder (frequent) and those moving irregularly (rare) were discriminated.

RESULTS

Control subjects showed an endogenous positive component at 400 ms (P400(p)) with an early exogenous negative potential (N160(p)) in the P-task. In the M-task, N160(m) and P400(m) were recorded. A deuteranope lacked P400(p) with normal P400(m). In SCD, P400(p) latency and N160(p)-P400(p) interval were increased with normal N160(p) latency. N160(m) latency was also increased while N160(m)-P400(m) interval was normal. In PD, there were no significant changes in the P-task but P400(m) latency was increased with normal N160(m) latency.

CONCLUSIONS

SCD patients may have not only abnormal higher processing in the P-pathway but abnormal fundamental processing in the M-pathway. PD may have impaired higher processing of the M-pathway with the preserved P-function.

Chromatic sensitive epilepsy: a variant of photosensitive epilepsy

We herein report 4 Japanese children who suffered epileptic seizures while watching a popular animated TV program. They showed a photoparoxysmal response that is more frequently observed in response to rapid color (blue/red) frame changes than monochromatic ones. These patients were all considered to have photosensitive epilepsy; however, chromatic sensitivity also plays an important role in the generation of such seizures.

Idiopathic cortical myoclonus restricted to the lower limbs: correlation between MEPs and 99mTc-ECD single photon emission computed tomography activation study

We report a 63-year-old woman with cortical reflex myoclonus restricted to the bilateral lower limbs. Somatosensory evoked cortical potentials to posterior tibial nerve stimulation were enlarged with C-responses. Jerk-locked back averaging of the EEG identified a cortical spike related to myoclonic jerks. Motor evoked potentials recorded from the abductor hallucis muscle showed an exaggerated late response. These findings suggest hyperexcitability of the sensorimotor cortex. 99mTc-ECD single photon emission computed tomography (SPECT) after stimulation of the posterior tibial nerve showed increased perfusion in the contralateral peri-Rolandic area which corresponded to the hyperexcitable region. A SPECT activation study as well as MEPs therefore can be employed to determine the hyperexcitable region in cortical myoclonus.

Visual evoked potentials in school children: a comparative study of transient and steady-state methods with pattern reversal and flash stimulation

OBJECTIVE

Flash visual evoked potentials (VEPs) are commonly used in pediatrics, because children are sometimes uncooperative. We performed a comparative study of transient and steady-state VEPs with pattern reversal (PR) and flash (light-emitting diode, LED) stimulation.

METHODS

We recorded VEPs in 15 boys and 17 girls (aged 6-12 years) using 4 different stimulus conditions. The latency and amplitude of transient VEPs (T-VEPs) were measured. Steady-state VEPs (S-VEPs) were Fourier analyzed, and both the phase and amplitude of the major components were obtained.

RESULTS

The mean P100 latency of LED T-VEPs was longer and had a greater variability than that of PR T-VEPs. The LED T-VEPs had an amplitude of about double that of PR T-VEPs. The first harmonic response in the LED and second harmonic in PR were the major components of S-VEPs. The phases of PR and LED S-VEPs had narrow angular dispersions and amplitudes showed marked intersubject variability. Sex and age had no significant effect on both T-VEPs and S-VEPs.

CONCLUSIONS

Reproducible VEPs with 4 stimulus conditions can be obtained in school children. T-VEPs and S-VEPs are clinically useful because these methods provide complementary information.

Effects of sex, height and age on motor evoked potentials with magnetic stimulation

Magnetic stimulation of the brain and cervical and lumbar spinal roots was performed on 48 healthy subjects in order to investigate the effects of sex, height and age on motor evoked potentials (MEPs). The compound muscle action potentials were recorded from the abductor pollicis brevis and abductor hallucis muscles. The central motor conduction time (CMCT) was measured between the cerebral cortex and the cervical root and also between the cerebral cortex and the lumbar root. A multiple regression analysis was used to determine which of the physical variables, namely sex, height and age, were significant. A significant gender difference was observed in the MEP latencies and CMCT of the leg, but not in those of the hand. Both height and age had a significant effect on the leg MEP latencies with a lesser effect on the hand MEP latencies. The leg CMCT was also significantly influenced by height and age, while the hand CMCT was not. These results thus suggest that physical variables are very important in defining normal MEPs, especially in the lower limbs. Therefore, when we assess motor function in patients with neurological disorders, both the patients and control groups should be matched for sex, height and age distribution.

The effect of magnetic coil orientation on the excitation of the median nerve

OBJECTIVE

We investigated the effect of magnetic coil orientation on the excitation of the median nerve in healthy subjects.

METHODS

An 8-shaped coil, 3.2 cm in outer diameter, was used. The median nerve was stimulated at the elbow while the compound muscle action potentials (CMAPs) of abductor pollicis brevis muscle were recorded at 4 different directions of the induced current: orthodromic, antidromic, medio-lateral and latero-medial.

RESULTS

We found that the amplitude of the CMAP was the greatest in a medio-lateral (ML) direction. We also measured the induced electric field in the saline tank that mimicked the forearm. The induced electric field and its spatial gradient were the greatest in the ML direction among 4 directions.

CONCLUSION

The fact that the forearm is a restrictive volume conductor may result in the different effects of coil orientation on the excitation of the median nerve at the elbow.

Acute myelitis with hyperIgEaemia and mite antigen specific IgE: atopic myelitis

An occurrence of acute localised myelitis was recently seen in four adult patients with atopic dermatitis who had hyperIgEaemia and mite antigen specific IgE. The total and mite antigen specific IgE was therefore studied in serum samples from 19 consecutive patients with acute localised myelitis of unknown aetiology, 56 patients with clinically definite multiple sclerosis, and 40 healthy controls. The total IgE concentration was significantly higher in acute localised myelitis (median=360 U/ml) than in multiple sclerosis (median=52 U/ml, p<0.0001) and the controls (median=85 U/ml, p=0.0002). The specific IgE to Dermatophagoides pteronyssinus was found more often in patients with acute localised myelitis (95%) than in patients with multiple sclerosis (34%, p<0.0001) and the controls (35%, p<0.0001) and the specific IgE to Dermatophagoides farinae was similar (acute localised myelitis 79%, multiple sclerosis 29% (p<0.0001), controls 30%, (p=0.0003). Atopic dermatitis coexisted more commonly in patients with acute localised myelitis (37%) than in patients with multiple sclerosis (0%, p<0.0001) and the controls (7.5%, p=0.0089). Therefore, acute localised myelitis with hyperIgEaemia, in which atopy to mite antigens seems to exist, may be a distinct subtype of allergic myelitis-that is, atopic myelitis.

Visual evoked cortical magnetic responses to checkerboard pattern reversal stimulation: a study on the neural generators of N75, P100 and N145

In an attempt to elucidate the neural generators of pattern reversal visual evoked potentials (PR-VEPs), we measured the visual evoked magnetic fields (PR-VEFs) using a 37-channel magnetoencephalography in six healthy young adults. A half-field checkerboard pattern was phase-reversed at a rate of 1 Hz to stimulate the right or left visual half-field, thus yielding 12 PR-VEFs in total from the six subjects. The simultaneously recorded scalp PR-VEPs showed three distinct components of N75, P100 and N145. Three corresponding components were also identified in the PR-VEFs with similar peak latencies (N75m, P100m and N145m). P100m and N145m were clearly identified in all 12 PR-VEFs, whereas N75m was observed in only nine of 12 PR-VEFs. The equivalent current dipoles (ECDs) of N75m, P100m and N145m were located closely to each other in the occipital cortex around the calcarine fissure contralateral to the stimulated visual field, when they were overlaid on the MRI. The reliability of dipole estimation was highest in P100m, followed by N145m while N75m showed the least reliability. The direction of the current flow of ECDs of N75m and N145m was from the medial to the lateral in the occipital cortex when viewed in a coronal section, whereas that for P100m was toward the medial. The ECD location of P100m changed according to the retinotopic organization when the upper or lower quadrant of the visual field was stimulated, with the ECDs being located in the lower or upper part, respectively, of the visual cortex. Our results therefore indicate that the neural origins of N75m, P100m and N145m of PR-VEFs are in the primary visual cortex on the contralateral side of the stimulated visual half-field, while the three components are physiologically distinct.

Multimodality visual evoked potentials in evaluating visual dysfunction in optic neuritis

Visual information is processed via multiple, parallel channels. The present study examined the clinical feasibility of multimodality visual evoked potentials (VEPs) in optic neuritis. We recorded transient VEPs to 30' checkerboard patterns, chromatic and achromatic sinusoidal gratings and apparent motion, and steady-state VEPs to achromatic gratings in 15 normal controls and 14 patients. VEPs to 30' checks were abnormal in 10 eyes (7 patients); however, considering all five modalities, abnormal responses were seen in 20 eyes (12 patients). Abnormality rates were not equal among the visual stimuli, which thus suggested possible dysfunction of individual subdivisions in the visual pathways. We conclude that use of multimodality VEPs may increase both understanding of the pathophysiology of the visual pathways and diagnostic yield.

Jerk-locked back averaging and dipole source localization of magnetoencephalographic transients in a patient with epilepsia partialis continua

In order to localize the generator site of epileptiform discharges, we applied the techniques of jerk-locked back averaging (JBA) of magnetoencephalographic (MEG) activities and dipole source localization in a patient with epilepsia partialis continua (EPC), who showed continuous, focal myoclonic jerks in the right arm. The myoclonic discharges in the right thenar muscle were used as a trigger pulse. JBA revealed consistent EEG and MEG transients that coincided consistently and constantly preceded the myoclonic jerks. The estimated dipoles of MEG were localized in a restricted area in the left precentral area, which closely correlated with the area of epileptic discharges recorded in electrocorticography. Therefore, JBA of MEG is considered to be a useful non-invasive method for localizing the epileptogenic area in EPC.

Bilateral striate cortex contusion presenting with cerebral asthenopia rather than cortical blindness

We report a 22-year-old female with a history of contusion of bilateral occipital lobes at the age of 1 year. Magnetic resonance imaging confirmed severe lesion in bilateral striate cortices which should have resulted in cortical blindness. However, she displayed a fairly good visual function presenting only cerebral asthenopia and the restriction of the visual field. A positron emission tomography revealed that no areas other than the primary visual cortices responded to visual stimuli. Thus, her residual vision may be attributable to plasticity of the visual cortex in humans.

Different effects of cholinergic agents on responses recorded from the cat visual cortex and lateral geniculate nucleus dorsalis

We investigated the effect of cholinergic agents on the cat visual evoked potentials (VEPs) recorded from the primary visual cortex (V1) and lateral geniculate nucleus dorsalis (LGNd) to determine on which level of the visual pathway the cholinergic system acts. VEPs to the alternation of 0.1 cycles per degree sinusoidal gratings at 1 and 4 Hz were recorded from N2O-anesthetized cats directly from the surface of V1 and LGNd. The depth of recording in LGNd was determined by the site where the maximal response was obtained by 1 Hz stimulation. VEPs to 4 Hz stimulation, which showed sinusoidal waveforms and were analyzed by fast Fourier transforms, were used as indicators for modulation by cholinergic agents. Physostigmine, an acetylcholinesterase inhibitor, 0.7 mg/kg i.v., suppressed the amplitude of the responses more at V1 (suppression ratio: mean +/- SD, 85.4 +/- 9.3%) than at LGNd (32.4 +/- 30.7%) (P < 0.05). Conversely, scopolamine, a muscarinic receptor blocker, 0.7 mg/kg i.v., increased the amplitude of the responses more at V1 (enhancement ratio: mean +/- SD, 60.3 +/- 22.3%) than at LGNd (-22.2 +/- 22.5%) (P < 0.05). These results indicate that the V1 changes reflect a direct cortical cholinergic effect, probably by modulating the cholinergic projection from the nucleus basalis of Meynert to V1.

Visual evoked potentials in the vicinity of the optic tract during stereotactic pallidotomy

We recorded visual evoked responses in eight patients with Parkinson's disease, using a depth electrode either at or below the stereotactic target in the ventral part of the globus pallidus internus (GPi), which is located immediately dorsal to the optic tract. Simultaneously, scalp visual evoked potentials (VEPs) were also recorded from a mid-occipital electrode with a mid-frontal reference electrode. A black-and-white checkerboard pattern was phase reversed at 1 Hz; check size was 50 min of arc . Pallidal VEPs to full field stimulation showed an initial positive deflection, with a latency of about 50 ms (P50), followed by a negatively with a mean latency of 80 ms (N80). The mean onset latency of P50 was about 30 ms. P50 and N80 were limited to the ventralmost of the GPi and the ansa lenticularis. Left half field stimulation evoked responses in the right ansa lenticularis region while right half field stimulation did not, and vice versa. These potentials thus seemed to originate posterior to the optic chiasm. The scalp VEPs showed typical triphasic wave forms consisting of N75, P100 and N145. The location of the recording electrode in the ansa lenticularis region did not modify the scalp VEP. These results suggest that P50 and N80 are near-field potentials reflecting the compound action potentials from the optic tract. Therefore, N75 of the scalp VEPs may represent an initial response of the striate cortex but not of the lateral geniculate nucleus.

Western versus Asian types of multiple sclerosis: immunogenetically and clinically distinct disorders

The polymorphism of HLA-DRB1, -DRB3, and -DRB5 genes as well as magnetic resonance images of the brain and spinal cord were studied in 57 Japanese patients with multiple sclerosis (MS). Twenty-three patients clinically displayed selective involvement of the optic nerve and spinal cord and were classified as having Asian-type MS. The other 34 patients had disseminated central nervous system involvement and were classified as having Western-type MS. Patients with Asian-type MS had fewer brain lesions shown by magnetic resonance imaging, but more gadolinium-enhanced spinal cord lesions than did patients with Western-type MS (47% vs 17%). Furthermore, the DR2-associated DRB1*1501 allele and DRB5*0101 allele were associated with Western-type MS (41.2%), but not with either Asian-type MS (0%) or healthy control subjects (14.2%). Heterogeneity in the immunogenetic background and in the magnetic resonance imaging features between the two subtypes of MS thus suggests the presence of two etiologically distinct diseases in Asians.

Normal variability of the amplitude and phase of steady-state VEPs

The present study quantifies the amplitude and phase variability of steady-state VEPs (S-VEPs) and compares this variability between subjects and between individual runs. The S-VEPs were recorded repeatedly in 14 normal subjects with varying spatial and temporal frequencies of sinusoidal gratings; 6 spatial frequencies (range 0.5-8.0 c/deg) with 3 temporal frequencies (4, 6 and 8 Hz) were used. A total of 75 responses were averaged and analyzed by the Fourier method. Four recordings were obtained in each spatio-temporal combination. In general, the phase data showed small inter- and intrasubject variability. As anticipated, the amplitude data showed a large degree of intersubject variability, although the intrasubject variability was very small. In addition, in some stimulus conditions the inter- and intrasubject variability increased, which thus suggested the existence of an optimal spatio-temporal combination. Therefore, these stimulus parameters should be taken into consideration when S-VEPs are applied in clinical practice.

The effect of binocular stimulation on each component of transient and steady-state VEPs

We recorded the monocular and binocular VEPs to the alternation of sinusoidal gratings in order to evaluate the binocular interaction in each component of transient and steady-state VEPs in 13 normal subjects. Three spatial frequencies (1.3, 2.6 and 5.3 c/deg) with a 90% contrast were used as visual stimuli. The latencies and amplitudes of N70 and P100 of the transient VEPs were measured. The steady-state VEPs were Fourier analyzed, and both the phase and amplitude of the second (2F) and fourth (4F) harmonic responses were obtained. Binocular interaction was influenced by spatial frequency such that a binocular summation or even an inhibition occurred. For the transient VEPs, a binocular summation was more pronounced in the amplitude of N70 than in that of P100 at all spatial frequencies. There were no significant effects of binocular stimulation on latencies of N70 or P100. However, the latencies of N70 and P100 showed different spatial frequency characteristics. For the steady-state VEPs, the amplitude of 2F revealed a binocular summation that was more pronounced at 5.3 c/deg, whereas the 4F amplitude showed binocular inhibition at 2.6 and 5.3 c/deg. The 2F phase showed binocular inhibition at all spatial frequencies, whereas no such inhibition was observed in the 4F phase. These results suggest that individual components of transient and steady-state VEPs are physiologically distinct and may therefore be generated from different neuronal populations in striate cortex.

Human VEPs to isoluminant chromatic and achromatic sinusoidal gratings: separation of parvocellular components

To extract the responses specific to the parvocellular system (color vision and form perception) in humans, visual evoked potentials (VEPs) in response to the onset of isoluminant chromatic (red-green) and achromatic (black-white) sinusoidal gratings were recorded in 15 young adults. Chromatic stimulation evoked a characteristic negative wave (N1) with peak latencies around 120 msec. The amplitude resembled an inverse U-shaped function against the spatial frequency with a peak at 2 c/deg. In contrast, VEPs to achromatic gratings showed different spatial frequency characteristics with a peak at 5.3 c/deg. With variations in the luminous intensity ratio between the red and green gratings, N1 was seen to respond maximally to isoluminant stimulation. These results indicate that the combined use of isoluminant chromatic and achromatic patterns could stimulate the parvocellular system selectively in humans.

Parvocellular and magnocellular contributions to visual evoked potentials in humans: stimulation with chromatic and achromatic gratings and apparent motion

Psychophysical evidence suggests that two major parallel pathways, the parvocellular (P) and the magnocellular (M) pathways, exist in humans. We herein report that responses specific to the P and M systems can be recorded in human visual evoked potentials (VEPs) by using the appropriate stimuli. The onset of isoluminant chromatic (red-green) and high contrast achromatic sinusoidal gratings were used for stimulating the P-system. A chromatic stimulation evoked a characteristic negative wave (N1) with peak latencies around 120 msec. The amplitude showed an inverse U-shaped function as a function of spatial frequency with a peak at 2 c/deg. In contrast, VEPs to achromatic (black-white) gratings showed different spatial frequency characteristics with a peak at 5.3 c/deg. By varying the luminous intensity ratio between the red and green gratings, N1 was found to reach a maximum during isoluminant stimulation. An apparent motion display was used for stimulating the M-system. The speed of alternation (i.e., the interstimulus interval (ISI)) was varied to record both the transient and steady-state VEPs. Transient VEPs showed triphasic waves with the major positive peak (P1) at around 120 ms. Steady-state VEPs were quasi-sinusoidal waveforms, depending on the ISI, and were quite stable across all subjects. There was a also high correlation between the motion threshold and the VEP amplitude. The above observations indicate that characteristic potentials may distinguish between these two parallel visual systems in humans. Thus, the combined use of isoluminant color and high contrast achromatic gratings and an apparent motion display is considered to be useful for evaluating both systems electrophysiologically.

Functional mapping of the sensorimotor cortex: combined use of magnetoencephalography, functional MRI, and motor evoked potentials

Combined use of magnetoencephalography (MEG), functional magnetic resonance imaging (f-MRI), and motor evoked potentials (MEPs) was carried out on one patient in an attempt to localise precisely a structural lesion to the central sulcus. A small cyst in the right frontoparietal region was thought to be the cause of generalised seizures in an otherwise asymptomatic woman. First the primary sensory cortex was identified with magnetic source imaging (MSI) of somatosensory evoked magnetic fields using MEG and MRI. Second, the motor area of the hand was identified using f-MRI during hand-squeezing. Then transcranial magnetic stimulation localised the hand motor area on the scalp, which was mapped onto the MRI. There was a good agreement between MSI, f-MRI and MEP as to the location of the sensorimotor cortex and its relationship to the lesion. Multimodality mapping techniques may thus prove useful in the precise localisation of cortical lesions, and in the preoperative determination of the best treatment for peri-rolandic lesions.

[Segmental muscular atrophy of unilateral upper limb associated with cervical disc herniation in a juvenile male]

A 25-year-old man first noticed atrophy of right upper arm at the age of 15. This symptom progressed for the following 3 years and then became stable. As he noted difficulty in elevating his right arm above the shoulder level, at the age of 25 he was admitted to our hospital. On neurological examination, he had right scapula alata, moderate atrophy and weakness of right triceps muscle. Right triceps reflex was absent. Other neurological examinations were normal. Needle electromyography revealed neurogenic patterns in the muscles of the C5-T1 segments. Cervical MRI and CT myelography revealed mild cervical disc protrusion toward the right side at the C5/6 level and atrophy of the middle and lower cervical cord on the right side, but nothing suggestive of the fexion myelopathy. The clinical manifestations of the patient resembled those of Hirayama disease, except for the distribution of the involved muscles. Since the most severely involved level of the cervical cord (C7 segment) corresponded to the level of the protruded cervical disc, it was suggested that the cervical disc herniation played an important role in the development of the myelopathy in this patient.

Aging and pattern visual evoked potentials

Visual abilities decline during senescence. Age-related declines cannot be attributed entirely to changes in optical factors (senile miosis and opacification of the ocular media) and must therefore be caused by changes in the visual pathways. Because pattern visual evoked potentials (VEPs) provide information regarding the sensory function and integrity of the visual system, recent research on age-related changes in VEPs is reviewed. The results of this review show that stimulus parameters of VEPs (luminance, contrast, spatial and temporal frequencies) modify the age-related changes in VEPs. The visual system consists of multiple, parallel channels which process different information. Therefore, it is hypothesized that aging may affect the specific functional subdivisions in the visual pathways differentially.

The interaction of the somatosensory evoked potentials to simultaneous finger stimuli in the human central nervous system. A study using direct recordings

In order to investigate the interaction of sensory electrophysiologic fields arising from the adjacent second (II) and third (III) fingers and the distant second and fifth (V) fingers, direct recordings of somatosensory evoked potentials (SEPs) were performed from the sensory and motor cortices, the sensory thalamic nucleus (nucleus ventralis caudalis, VC) and the cuneate nucleus in humans during neurosurgical operations. Electrical stimulation was given to the II, III or V fingers individually, and also to pairs of either the II and III fingers or the II and V fingers simultaneously. The interaction ratio (IR) was devised as the ratio of amplitude attenuation caused by the simultaneous stimulation to two fingers compared with the amplitude of the arithmetically summed SEPs to the individual stimulation of two fingers. The IRs were calculated on N20 and P25 from the sensory cortex, P22 from the motor cortex, P17thal from the VC, and N16cune and P35cune from the cuneate nucleus. With both stimulations to the II and III fingers and the II and V fingers, P25 showed the greatest IR, followed by P22, then by P17thal, with N16cune exhibited the smallest IR. N20 and P35cune showed similar IRs and significantly greater IRs with II and III finger stimulation compared with II and V finger stimulation. These results thus indicate that the interaction of somatosensory impulses occurs in several structures along the sensory pathway in CNS, including the cuneate nucleus, the sensory thalamic nucleus, as well as sensory and motor cortices, with the greatest IRs in the cerebral cortices and the weakest ones in the brain-stem.(ABSTRACT TRUNCATED AT 250 WORDS)

[Visual information processing in humans]

Recent advances in parallel information processing of primates and humans have been reviewed. First, I review what is known about physiology and anatomy of the primate visual pathways. Several lines of evidence suggest that the primate visual system consists of the parvocellular (P) and the magnocellular (M) pathways. M-system originates from the A retinal ganglion cells that project to the visual cortex (V1) via the magnocellular layers of the lateral geniculate nucleus (LGN). This system plays an important role for motion and stereopsis. P-system derives from the B retinal ganglion cells that project to V1 via the parvocellular layers of the LGN. This system shows selectivity for color vision and form perception. Second, I focus on the information processing of the human visual pathways. Psychophysical evidence suggests that there are also P and M systems in humans. However, there have been few electrophysiological studies which intend to separate the responses specific to P and M systems in human visual evoked potentials (VEPs). Based on the physiological distinctions between P and M systems, the use of isoluminant color patterns and apparent motion display allows us to evaluate P and M systems, respectively.

Temporal frequency deficit in patients with senile dementia of the Alzheimer type: a visual evoked potential study

To study the temporal aspect of visual processing of senile dementia of the Alzheimer type (SDAT), we recorded the steady-state visual evoked potentials (VEPs) to LED goggle stimulation at five different temporal frequencies in 14 patients with SDAT and 14 control subjects. For comparison, we also studied 14 patients with vascular dementia (VD). All subjects were women, and their ages were closely matched. Temporal frequencies were 5, 10, 15, 20, and 30 Hz. The steady-state VEPs were Fourier analyzed, and both the amplitude and phase of the first and second harmonic responses were obtained. There was a significant difference in the amplitude across the three groups for stimulation at 15, 20, and 30 Hz, but no difference at a stimulation of 5 and 10 Hz. Multiple comparison tests revealed that patients with SDAT had a significantly smaller amplitude than normal controls. Patients with VD had lower amplitudes than normal subjects, but this was not statistically significant. In the phase data, there were also no statistically significant differences across the three groups for any of the temporal frequencies. These results indicate that a temporal frequency deficit exists in SDAT. This phenomenon may be explained by the pathology that affects the early stage of visual signal processing.

Periodic synchronous discharges and visual evoked potentials in Creutzfeldt-Jakob disease: PSD-triggered flash VEPs

We have developed the technique of flash visual evoked potentials (VEPs) triggered by periodic synchronous discharges (PSDs) to investigate the interaction between PSDs and VEPs in 3 patients with Creutzfeldt-Jakob disease (CJD). This technique enables us to explore the cerebral pathophysiology underlying CJD. Unexpectedly, we found that PSDs and VEPs did not interact even when VEPs were evoked in close temporal proximity to PSDs. Thus, it appears that PSDs are generated by a different neuronal mechanism from that involved in VEP generation.

Vitamin B12 metabolism and massive-dose methyl vitamin B12 therapy in Japanese patients with multiple sclerosis

Serum vitamin B12 levels and unsaturated vitamin B12 binding capacities were measured in 24 patients with multiple sclerosis (MS), 73 patients with other neurological disorders and 21 healthy subjects. There was no decrease in the vitamin B12 levels, however, a significant decrease in the unsaturated vitamin B12 binding capacities was observed in patients with MS when compared with other groups. A massive dose of methyl vitamin B12 (60 mg every day for 6 months) was administered to 6 patients with chronic progressive MS, a disease which usually had a morbid prognosis and widespread demyelination in the central nervous system. Although the motor disability did not improve clinically, the abnormalities in both the visual and brainstem auditory evoked potentials improved more frequently during the therapy than in the pre-treatment period. We therefore consider that a massive dose methyl vitamin B12 therapy may be useful as an adjunct to immunosuppressive treatment for chronic progressive MS.

Effect of spatial frequency on transient and steady-state VEPs: stimulation with checkerboard, square-wave grating and sinusoidal grating patterns

We recorded VEPs to the alteration of checkerboard, square-wave grating and sinusoidal grating patterns to evaluate the contribution of the fundamental spatial frequency and higher harmonic components in 12 normal subjects. Their fundamental spatial frequencies were equated and ranged from 0.5 to 8.0 c/deg. Both the transient VEP (T-VEP) and steady-state VEP (S-VEP) were obtained. The latency and amplitude of P100 of T-VEPs were measured. S-VEPs were Fourier analyzed, and phase and amplitude of the second harmonic response were measured. The mean P100 latency and the mean phase had a U-shaped function with a peak at a fundamental spatial frequency of 2.0 c/deg irrespective of the stimulus patterns, while the mean P100 amplitude and the mean amplitude of S-VEPs did not show such spatial selectivity. At low and medium spatial frequencies, differences in P100 latency, phase and amplitude between pattern types were more pronounced. However, this difference became insignificant at high spatial frequencies. These results indicate that VEP responses are predominantly determined by the fundamental spatial frequency, and that the contribution of higher harmonics to VEP responses is not negligible. Our results are consistent with the concept that the human visual system may use spatial frequency-domain information.

Primary progressive versus relapsing remitting multiple sclerosis in Japanese patients: a combined clinical, magnetic resonance imaging and multimodality evoked potential study

Thirty-five Japanese patients with relapsing remitting multiple sclerosis (RRMS) and 11 Japanese patients with primary progressive MS (PPMS) were compared by a combined clinical, magnetic resonance imaging (MRI) and multimodality evoked potential (MEP) study. Patients with PPMS showed a more common occurrence of gait disturbance as the initial symptoms as well as a more common occurrence of cerebellar symptomatology than did those with RRMS, while spinal cord symptomatology was frequently observed in both conditions. On brain MRI, patients with PPMS had 3 times more lesions than did those with RRMS (P < 0.001, chi 2-test). The percentage of infratentorial lesions was also significantly higher in PPMS than in RRMS on MRI. Moreover, we found a significantly higher frequency of abnormal records in visual, brainstem auditory and somatosensory evoked potentials in PPMS than in RRMS. Interestingly, clinically unexpected abnormalities were significantly more common in PPMS than in RRMS throughout all modalities of MEPs. Thus, in Eastern MS, there exists a distinction between PPMS and RRMS in the MRI and MEP findings as well as in the clinical findings. Our result therefore suggest that there may be two distinct subtypes in MS.

[The variation of human contrast sensitivity with age and optic nerve disease]

Contrast sensitivity function (CSF) was measured in 85 normal subjects and in 23 patients with optic neuropathy, using a personal computer and video monitor system. CSF in normal controls showed an inverted U-shaped function against spatial frequency with a peak at about 4-6 cycles/degree. At higher spatial frequencies, contrast sensitivity decreased with increasing age. CSF in patients was compared with Snellen acuity, visual field examination, critical flicker fusion frequency (CFF) and pattern VEP (P-VEP). CSF and P-VEP were more sensitive than the others in detecting visual dysfunction in optic nerve disease. These results suggest that ranges of normal values should be established for each of several age groups, and that CSF is useful for evaluating visual dysfunction.

Age-related changes in pattern visual evoked potentials: differential effects of luminance, contrast and check size

We recorded visual evoked potentials (VEPs) to checkerboard pattern-reversal stimulation in 109 normal subjects (51 males and 59 females; aged 19-84 years) in order to study the aging effect on the multiple channels of the visual system in humans. Transient VEPs to 3 check sizes (15', 30' and 50') were obtained by monocular stimulation. Two test conditions were employed: (1) a high luminance (180 cd/m2) and a low luminance (11 cd/m2) both with a fixed contrast (90%), and (2) a high contrast (85%) and a low contrast (10%) both at a fixed luminance (57 cd/m2). The major features of our results included: (1) the presence of a curvilinear relationship between P100 latency and age for all conditions, while the P100 amplitude did not show any such aging effect, (2) the age-latency function was similar between the two luminance conditions, while it was different between the two contrast conditions, and (3) the differential age effect on the P100 latency caused by changes in contrast depended on the check size. These results suggest that age-related changes in the human visual system are not uniform, but rather are different in the specific functional subdivisions. It is thus hypothesized that aging may differentially influence the separate channels of the human visual system.

[Adverse effect of antiepileptic drugs on the visual recognition--a contrast sensitivity function study]

Contrast sensitivity function (CSF) was measured in 16 patients (14-60 yr.) with epilepsy to investigate adverse effect of antiepileptic drugs on the central nervous system. Eight patients were treated with phenytoin, while 8 were given polytherapy (phenytoin in combination with phenobarbital, carbamazepine or valproic acid). Thirty-one normal controls (19-59 yr.) were also subjected to this study. Vertical sinusoidal gratings with various spatial frequencies (0.5-20.0 c/deg) were presented on a video monitor. Contrast sensitivity (reciprocal of threshold contrast) was determined at each spatial frequency. CSF of normal subjects showed an inverted U-shaped function against the spatial frequencies with a peak at 6 c/deg (medium size pattern). There was no significant difference in CSF values between normal controls and patients with epilepsy. However, 3 patients with polytherapy showed the significant reduction of contrast threshold. Since these patients did not complain of visual disturbance with normal visual acuity, CSF abnormality was considered as having subclinical visual dysfunction. These results suggest that CSF is useful for evaluating the adverse effect of antiepileptic drugs on the visual recognition, and that polytherapy is responsible for CSF abnormality. Therefore, monotherapy should be scheduled from the onset of therapy.

The neurophysiologic significance of frontal negativity in pattern-reversal visual-evoked potentials

To demonstrate that the frontal negative potential (N100) does exist in response to pattern-reversal visual stimulation and its independence of the dipole source from the major occipital positive potential (P100), modifications of P100 and N100 with changes in the check size, contrast, and luminance of the stimulus pattern were studied in healthy subjects. Eight different check sizes (10-90 min of arc), eight different contrast levels (10-85%), and six different luminance levels (11-180 cd/m2) were used. Changing the stimulus conditions modified the latencies and amplitudes of P100 and N100 in different ways. P100 latency had a band pass spatial tuning function against check size; N100 latency did not. P100 was sensitive to changes in contrast and luminance; N100 was less dependent on these parameters. These findings suggest the existence of different physiologic properties for N100. Consequently, frontal negativity is considered to be independent of P100.

Auditory middle-latency responses in patients with localized and non-localized lesions of the central nervous system

Auditory middle-latency responses were recorded in 45 neurological patients. In 4 patients with localized lesions in the thalamus, or subcortical white matter, the component Na was attenuated or delayed at T3, Cz and T4, exclusively on stimulation of the ear contralateral to the lesion. In 5 patients with temporal lobe lesions with receptive aphasia, the amplitude of component Pa was decreased on the lesion side (T3), regardless of the side of stimulation. These findings suggest that Na is generated from a subcortical structure and Pa is generated from the temporal cortex. In 25 patients with diffuse CNS lesions, V-Na interpeak latency was prolonged in 2 cases.

Direct spinal versus peripheral nerve stimulation as monitoring techniques in epidurally recorded spinal cord potentials

We recorded spinal cord evoked potentials (SCEPs) and spinal somatosensory evoked potentials (spinal SEPs) in 30 operations following stimulation of the epidural spinal cord and the peripheral nerve, respectively, to compare their feasibility as an intraoperative technique for spinal cord monitoring. SCEPs produced quicker responses and had larger amplitudes with simpler waveforms. SCEPs could reflect residual function of the pathological spinal cord and predict the postoperative clinical outcome, findings which are not observed with spinal SEPs. Moreover, SCEPs had a much higher sensitivity to spinal cord insult. Therefore, we conclude that the SCEPs were more appropriate indicator than the spinal SEPs as an intra-operative monitoring method for spinal cord function.

Effect of check size on the pattern reversal visual evoked potential

Modifications of the components of pattern-reversal visual evoked potentials (PR-VEP) with changes in check size of the stimulating pattern were studied in 11 healthy subjects. We made use of 8 different check sizes ranging between 10 and 90 min of arc. Changes in the check size modified in different manners the latencies and amplitudes of N75, P100 and N145. Two-step statistical analyses using the polynomial regression analysis method revealed significant modifications of latencies of the 3 components, but non-significant modifications of the amplitudes, except for N75. The latency and amplitude of N75 showed a significant inverse linear relationship with the logarithm of the check size, while the P100 and N145 latencies showed significant curvilinear relationships, with minimal latencies at check sizes around 35 min. These findings suggest different physiological properties of N75 from those of P100 and N145, and hence, the necessity to establish normal values for each check size of stimulation, for application in clinical studies.

Origin and distribution of brain-stem somatosensory evoked potentials in humans

The distribution of somatosensory evoked potentials (SEPs) recorded from the brain-stem surface was studied to investigate their generator sources in 14 patients during surgical exploration of the posterior fossa. Two distinct SEPs of different morphologies and electrical orientation were obtained by median nerve stimulation. A small positive-large negative-late prolonged positive wave was recorded from the cuneate nucleus and its vicinity. There was a phase-reversal between the cuneate nucleus and the ventral surface of the medulla, depicting a dipole for dorso-ventral organization. From the pons and midbrain, triphasic waves with predominant negativity were obtained. This type of SEP had identical wave forms between the dorsal, lateral and ventral surface of the pons and midbrain. It showed an increase in negative peak latency as the recording sites moved rostrally, suggesting an ascending axial orientation. In a patient with pontine hemorrhage, the killed end potential, a large monophasic positive potential was obtained from the lesion. This potential occurs when an impulse approaches but never passes beyond the recording electrode. Therefore, the triphasic SEP from the pons and midbrain reflects an axonal potential generated in the medial lemniscal pathway.

Clinical relevance of phase of steady-state VEPs to P100 latency of transient VEPs

Pattern visual evoked potentials (VEPs) to transient and steady-state stimulation were recorded in 10 normal subjects at 4 levels of luminance (180, 57, 22 and 11 cd/m2). VEPs were also recorded in 5 patients with optic neuropathy at a fixed luminance (180 cd/m2). The relationship between P100 latency of transient VEPs (T-VEPs) and the phase of steady-state VEPs (S-VEPs) was analyzed. As luminance decreased in normal subjects, P100 latency was prolonged and the phase lag increased. A significant linear relationship between the P100 latency and phase was found. Patients showed both the prolonged P100 latency and the delayed phase. The simple linear regression line of the phase-P100 latency function of normal subjects closely matched the patients' values. These results suggest that changes in the phase may be equivalent to changes in the P100 latency. S-VEPs, therefore, may be clinically useful in assessing visual function.

Frontal negativity of pattern-reversal visual evoked potentials in humans

We investigated the nature of negative potential in the frontal region with an approximate latency of 100 ms ('frontal negativity') as a component of pattern-reversal visual evoked potential (PVEP) in healthy human subjects. It was recorded by stimulation of one-half of the visual field, with different reference electrodes and with experimental manipulations of the stimulating visual field ('central scotomata' and 'peripheral constriction'). A negative potential field was demonstrated to be localized in the frontal region, and its physiological properties detected by the visual field manipulations were shown to be different from those of the occipital positive (P100) and negative (N105) components of PVEP. We conclude, therefore, that frontal negativity of PVEP is an actual electrical event generated in the frontal region, independent of P100 and N105.

Usefulness of epidurally evoked cortical potential monitoring during cervicomedullary glioma surgery

This report describes a patient with an intramedullary ependymoma at the region of the cervicomedullary junction in whom there was an abolition of somatosensory evoked potentials following median nerve stimulation. During intraoperative monitoring of cortical potentials elicited by epidural cervical cord stimulation, the tumor was removed. Posterior epidural stimulation appeared to depolarize more ascending fibers than did stimulation of a single peripheral nerve. We recommend that, in cases of operations in this vital area, epidurally evoked cortical potentials be monitored intraoperatively.

Electroretinograms to checkerboard pattern reversal in cats: physiological characteristics and effect of retrograde degeneration of ganglion cells

Pattern electroretinograms (P-ERGs) evoked by alternating checks were studied in cats. Spatial frequency functions for transient and steady-state P-ERG waves showed a bimodal distribution with a preferred frequency at 0.6-0.75 c/deg and a second amplitude increase at frequencies lower than 0.5 c/deg. Decreasing the pattern luminance by 0.5 log units produced a shift of the spatial tuning curve toward lower spatial frequencies. No temporal tuning was noted in the temporal frequency functions. The bimodal distribution suggests that at spatial frequencies higher than 0.5 c/deg, the tuning reflects a 'contrast response' originating in cells with center surround organization. At spatial frequencies below 0.5 c/deg, the 'luminance response' becomes predominant and is generated in cells sensitive to mean luminance changes. Transient and steady-state P-ERGs to medium and high spatial frequencies were abolished by section of the optic nerve, while low spatial frequency stimuli at or below 0.3 c/deg continued to evoke P-ERGs at 1, 5 and 10 months after surgery. Quantitative whole mount retina microscopic examination confirmed the retrograde degeneration of the ganglion cells. It is concluded that both transient and steady-state P-ERGs to small and medium spatial frequencies checks are predominantly related to ganglion cell activity, while P-ERGs to low spatial frequencies reflect preganglionic cell activity.

Nonfamilial prealbumin-type amyloid polyneuropathy

A 53-year-old man with nonfamilial prealbumin-type amyloid polyneuropathy had severe motor, sensory, and autonomic polyneuropathy, beginning at age 48 years. These clinical features closely resembled familial amyloid polyneuropathy (FAP), but abnormal serum prealbumin levels, specific to FAP (Japanese type), were not detected by radioimmunoassay; DNA sequence for prealbumin was normal. Thus, the diagnosis of FAP was excluded. A possible diagnosis of systemic senile amyloidosis was also considered.