Somatosensory potentials evoked by magnetic stimulation of lumbar roots, cauda equina, and leg nerves

Effects of different modalities of afferent stimuli of the lumbo-sacral area on control of lumbar paravertebral muscles

Somatosensory feedback to the central nervous system is essential to plan, perform and refine spine motor control. However, the influence of somatosensory afferent input from the trunk on the motor output to trunk muscles has received little attention. The objective was to compare the effects of distinct modalities of afferent stimulation on the net motoneuron and corticomotor excitability of paravertebral muscles. Fourteen individuals were recruited. Modulation of corticospinal excitability (motor-evoked potential [MEP]) of paravertebral muscles was measured when afferent stimuli (cutaneous noxious and non-noxious, muscle contraction) were delivered to the trunk at 10 intervals prior to transcranial magnetic stimulation. Each peripheral stimulation was applied alone, and subsequent EMG modulation was measured to control for net motoneuron excitability. MEP modulation and MEP/EMG ratio were used as measures of corticospinal excitability with and without control of net motoneuron excitability, respectively. MEP and EMG modulation were smaller after evoked muscle contraction than after cutaneous noxious and non-noxious stimuli. MEP/EMG ratio was not different between stimulation types. Both MEP and EMG amplitudes were reduced after evoked muscle contraction, but not when expressed as MEP/EMG ratio. Noxious and non-noxious stimulation had limited impact on all variables. Distinct modalities of peripheral afferent stimulation of the lumbo-sacral area differently modulated responses of paravertebral muscles, but without an influence on corticospinal excitability with control of net motoneuron excitability. Muscle stimulation reduced paravertebral activity and was best explained by spinal mechanisms. The impact of afferent stimulation on back muscles differs from the effects reported for limb muscles.

Trigeminal sensory input elicited by electric or magnetic stimulation interferes with the central motor drive to the intrinsic hand muscles

In 6 normal subjects, unilateral supraorbital magnetic or electric stimulation resulted in a consistent symmetrical inhibition of the motor evoked potentials (MEPs) of the relaxed and preactivated first dorsal interosseus (FDI) muscle. A supraorbital stimulus caused a significant reduction in amplitude when the trigeminal CS was given 30 to 65 ms before transcranial magnetic stimulation (TMS). In addition, supraorbital magnetic stimulation induced a bilateral EMG suppression of the isometrically contracting FDI muscles, starting about 40 to 50 ms after the magnetic stimulus. In 4 subjects, MEPs evoked by transcranial electric stimulation or by TMS during slight muscle contraction showed a comparable trigeminomotor inhibition. These findings demonstrate that electromagnetic stimulation of trigeminal afferents interferes with the motor output to the intrinsic hand muscles inducing a bilateral inhibition which is probably mediated by a multisynaptic subcortical network. In all 6 subjects, TMS over the motor hand area or the cerebellum elicited a reproducible blink reflex. Since the blink reflex is a sensitive indicator of trigeminal excitation, one has to assume that TMS is associated with a significant excitation of trigeminal afferents. Therefore, trigeminomotor inhibition has to be considered in all TMS studies that use a conditioning-test design.

Sympathetic skin responses evoked by magnetic stimulation of the neck

We studied sympathetic skin responses (SSRs) following magnetic stimulation of the neck in 40 normal subjects and 54 patients with neurological diseases and active sweat gland densities (ASGDs) at the foot induced by pilocarpine in 39 patients. SSRs at the hand following magnetic stimulation showed the lowest coefficients of variability of the latencies and amplitudes in eight consecutive responses compared with SSRs following other types of stimuli (electrical and auditory stimulation, and deep inspiration) in 12 normal subjects. Fourteen of 38 patients with neuropathies (37%) showed the presence of SSRs after magnetic stimulation, but not after median nerve stimulation, although SSRs to magnetic stimulation corresponded with those to nerve stimulation in all patients with multiple sclerosis or multiple system atrophy. These results suggest that the absence of SSRs after nerve stimulation in patients with neuropathies may be due to abnormalities of the peripheral sensory afferent fibers. ASGDs significantly correlated with SSRs at the foot following magnetic stimulation, but not with those following nerve stimulation in patients with neuropathies. Magnetic stimulation of the neck is the highly reproducible method of evoking SSRs because this technique is able to produce strong sensory afferent inputs proximally. Furthermore, SSRs following magnetic stimulation, little influenced by sensory afferent fiber involvement, are very useful for evaluating the postganglionic sympathetic function in patients with neuropathies.

Nerve, spinal cord and brain somatosensory evoked responses: a comparative study during electrical and magnetic peripheral nerve stimulation

Somatosensory evoked potentials (SEPs) and compound nerve action potentials (cNAPs) have been recorded in 15 subjects during electrical and magnetic nerve stimulation. Peripheral records were gathered at Erb's point and on nerve trunks at the elbow during median and ulnar nerve stimulation at the wrist. Erb responses to electrical stimulation were larger in amplitude and shorter in duration than the magnetic ones when 'electrical' and 'magnetic' compound muscle action potentials (cMAPs) of comparable amplitudes were elicited. SEPs were recorded respectively at Cv7 and on the somatosensory scalp areas contra- and ipsilateral to the stimulated side. SEPs showed a statistically significant difference in amplitude only for the brachial plexus response and for the 'cortical' N20-P25 complex; differences were not found between the magnetic and electrical central conduction times (CCTs) or for the peripheral nerve response latencies. Magnetic stimulation preferentially excited the motor and proprioceptive fibres when the nerve trunks were stimulated at motor threshold intensities.

Magnetic stimulation of muscle evokes cerebral potentials

Somatosensory evoked potentials (SEPs) were recorded from the scalp in man to magnetic stimulation of various skeletal muscles. The potentials consisted of several components, the earliest of which decreased in latency as the stimulated site moved rostrally, ranging from 46 msec for stimulation of the gastrocnemius, to 14 msec for stimulation of the deltoid. Experiments were performed to distinguish the mechanisms by which magnetic stimulation of the muscle was effective in evoking these cerebral potentials. For the gastrocnemius, the intensity of the magnetic stimulus needed for evoking cerebral potentials was less than that required for activating mixed or sensory nerves in proximity to the muscle belly (eg, posterior tibial nerve in the popliteal fossa, sural nerve at the ankle). Vibration of the muscle or passive lengthening of the muscle, procedures which activate muscle spindles, were accompanied by a significant attenuation of the potentials evoked by magnetic stimulation of the muscle. Anesthesia of the skin underlying the stimulating coil had no effect on the latency or amplitude of the early components of the magnetically evoked potentials, whereas electrically evoked potentials from skin electrodes were abolished. Thus, the cerebral potentials accompanying magnetic stimulation of the muscle appear to be due to activation of muscle afferents. We suggest that magnetic stimulation of muscle can provide a relatively simple method for quantifying the function of muscle afferents originating from a wide variety of skeletal musculature.

Cortical somatosensory potentials evoked by magnetic stimulation: effect of body height, age, and stimulus intensity

Cortical somatosensory evoked potentials elicited by non-invasive magnetic stimulation at Th10, Th12, and L5 vertebral levels and at mid-gluteus and ankle were studied in 45 normal controls varying in body height and age. Peak latencies of P2 evoked by ankle, mid-gluteus and L5 stimulation were correlated with body height. However, P2 latencies evoked by Th10 and Th12 stimulation were independent of body height. In contrast, all N2 latencies evoked by Th10, Th12, L5, mid-gluteus and ankle were correlated with body height. There were no correlations between latencies of P3 and N3 and body height. No peak latencies of cortical components were affected by age within the age group studied (15-67 years). In the intensity study, N2 showed double peaks when low to moderate stimulus intensities were applied to Th12 vertebra. Furthermore, in 2 patients with mild somatosensory dysfunction of lumbar roots or cord, N2 evoked by L5 stimulation revealed double peaks with prolonged interpeak latencies between the first peak of N2 and P3, which might be related to the temporal dispersion of the afferent fibers. These data suggest that the N2 component is induced by both fast and slow afferent fibers.