Contingent negative variation and movement-related cortical potentials in parkinsonism

Early and late contingent negative variation (CNV) reflect different aspects of deficits in schizophrenia

Abnormal reward processing and psychomotor slowing are well-known in schizophrenia (SZ). As a slow frontocentral potential, contingent negative variation (CNV) is associated with anticipatory attention, motivation and motor planning. The present study aims to evaluate the early and late amplitude and latencies of CNV in patients with SZ compared to healthy controls during a reward processing task and to show its association with clinical symptoms. We recruited 21 patients with SZ and 22 healthy controls to compare early and late CNV amplitude and latency values during a Monetary Incentive Delay (MID) Task between groups. Patients' symptom severity, levels of negative symptoms and depressive symptoms were assessed. Clinical features of the patients were further examined for their relation with CNV components. In conclusion, we found decreased early CNV amplitudes in SZ during the reward condition. They also displayed diminished and shortened late CNV responses for incentive cues, specifically at the central location. Furthermore, early CNV amplitudes exhibited a significant correlation with positive symptoms. Both CNV latencies were linked with medication dosage and the behavioural outcomes of the MID task. We revealed that early and late CNV exhibit different functions in neurophysiology and correspond to various facets of the deficits observed in patients. Our findings also emphasized that slow cortical potentials are indicative of deficient motivational processes as well as impaired reaction preparation in SZ. To gain a deeper understanding of the cognitive and motor impairments associated with psychosis, future studies must compare the effects of CNV in the early and late phases.

The cortical N1 response to balance perturbation is associated with balance and cognitive function in different ways between older adults with and without Parkinson's disease

Mechanisms underlying associations between balance and cognitive impairments in older adults with and without Parkinson's disease are poorly understood. Balance disturbances evoke a cortical N1 response that is associated with both balance and cognitive abilities in unimpaired populations. We hypothesized that the N1 response reflects neural mechanisms that are shared between balance and cognitive function, and would therefore be associated with both balance and cognitive impairments in Parkinson's disease. Although N1 responses did not differ at the group level, they showed different associations with balance and cognitive function in the Parkinson's disease vs. control groups. In the control group, higher N1 amplitudes were correlated with lower cognitive set shifting ability and lower balance confidence. However, in Parkinson's disease, narrower N1 widths (i.e., shorter durations) were associated with greater parkinsonian motor symptom severity, lower balance ability and confidence, lower mobility, and lower overall cognitive function. Despite different relationships across populations, the present results suggest the N1 response reflects neural processes related to both balance and cognitive function. A better understanding of neural mechanisms linking balance and cognitive function could provide insight into associations between balance and cognitive decline in aging populations.

Movement-related EEG signatures associated with freezing of gait in Parkinson's disease: an integrative analysis

Freezing of gait is the most severe gait deficit associated with Parkinson's disease and significantly affects patients' independence and consequently their quality of life. The lack of a clear understanding of its underlying neurophysiological mechanism has resulted in limited effectiveness of the current treatment options. In this study, we investigated EEG features over (pre-)supplementary motor area and primary motor cortex during a simple cue-based ankle dorsiflexion movement. These features include movement-related cortical potentials (0.05-5 Hz) and brain oscillations (1-50 Hz). Electromyogram signal from the tibialis anterior muscle of the dominant foot was used to determine the movement onset. The EEG features before, during and following the onset of the movement were compared among three groups of participants: patients with freezing (N = 14, 11 males), patients without freezing (N = 14, 13 males) and healthy age-matched controls (N = 13, 10 males) with 15 recorded trials for each individual. Additionally, Parkinson's disease patients with freezing of gait were separated into mild (N = 7) and severe cases (N = 5), so that EEG features associated with freezing severity could be investigated. The results indicated significant differences between patients with severe freezing of gait compared to healthy controls and patients without freezing of gait. In addition, patients with mild and severe freezing represented cortical activity differences. For patients with freezing, the initial component of movement-related cortical potential is significantly lower than that of the healthy controls (P = 0.002) and is affected by the severity of freezing. Furthermore, a striking absence of beta frequency band (12-35 Hz) desynchronization was observed in patients with freezing, especially low-beta frequency band over Cz, before the movement, which was also associated with the severity of the freezing of gait. Low-beta (13-20 Hz) and high-beta (21-35 Hz) frequency band activities represented unique features for each group. Beta event-related desynchronization over Cz present in healthy controls prior to movement onset, was partially replaced by the theta band (4-8 Hz) synchrony in patients with freezing. Patients with severe freezing also represented some level of theta band synchronization over contralateral supplementary motor area. This suggests the involvement of cognitive processing over the motor cortex in controlling cue-based voluntary movement as a compensatory mechanism associated with freezing of gait. The EEG features identified in this study are indicative of important freezing of gait clinical characteristics such as severity and contribute to a better understanding of the underlying neurophysiology of the mysterious phenomenon of freezing of gait.

Clinical Efficacy and Dosing of Vibrotactile Coordinated Reset Stimulation in Motor and Non-motor Symptoms of Parkinson's Disease: A Study Protocol

Enhanced neuronal synchronization of the subthalamic nucleus (STN) is commonly found in PD patients and corresponds to decreased motor ability. Coordinated reset (CR) was developed to decouple synchronized states causing long lasting desynchronization of neural networks. Vibrotactile CR stimulation (vCR) was developed as non-invasive therapeutic that delivers gentle vibrations to the fingertips. A previous study has shown that vCR can desynchronize abnormal brain rhythms within the sensorimotor cortex of PD patients, corresponding to sustained motor relief after 3 months of daily treatment. To further develop vCR, we created a protocol that has two phases. Study 1, a double blinded randomized sham-controlled study, is designed to address motor and non-motor symptoms, sensorimotor integration, and potential calibration methods. Study 2 examines dosing effects of vCR using a remote study design. In Study 1, we will perform a 7-month double-blind sham-controlled study including 30 PD patients randomly placed into an active vCR or inactive (sham) vCR condition. Patients will receive stimulation for 4 h a day in 2-h blocks for 6 months followed by a 1-month pause in stimulation to assess long lasting effects. Our primary outcome measure is the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III off medication after 6 months of treatment. Secondary measures include a freezing of gait (FOG) questionnaire, objective motor evaluations, sensorimotor electroencephalography (EEG) results, a vibratory temporal discrimination task (VTDT), non-motor symptom evaluations/tests such as sleep, smell, speech, quality of life measurements and Levodopa Equivalent Daily Dose (LEDD). Patients will be evaluated at baseline, 3, 6, and 7 months. In the second, unblinded study phase (Study 2), all patients will be given the option to receive active vCR stimulation at a reduced dose for an additional 6 months remotely. The remote MDS-UPDRS part III off medication will be our primary outcome measure. Secondary measures include sleep, quality of life, objective motor evaluations, FOG and LEDD. Patients will be evaluated in the same time periods as the first study. Results from this study will provide clinical efficacy of vCR and help validate our investigational vibrotactile device for the purpose of obtaining FDA clearance. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04877015.

Neural correlates of speech and limb motor timing deficits revealed by aberrant beta band desynchronization in Parkinson's disease

OBJECTIVE

We used a classical motor reaction time paradigm to examine the effects of Parkinson's disease (PD) on the mechanisms of speech production and upper limb movement.

METHODS

Electro-encephalography (EEG) signals were recorded in PD and control groups during speech vowel production and button press tasks in response to temporally predictable and unpredictable visual stimuli.

RESULTS

Motor reaction times were slower in PD vs. control group independent of stimulus timing and movement modality. This effect was accompanied by stronger desynchronizations of low beta (13-18 Hz) and high beta (18-25 Hz) band neural oscillations in PD vs. control prior to the onset of speech and hand movement. In addition, pre-movement desynchronization of beta band oscillations were correlated with motor reaction time in control subjects with faster responses associated with weaker beta band desynchronizations during the planning phase of movement. However, no such effect was found in the PD group.

CONCLUSIONS

We suggest that the aberrant pattern of beta band desynchronization is a neural correlate of speech and upper limb motor timing deficits as a result of cortico-striatal pathology in PD.

SIGNIFICANCE

These findings motivate interventions targeted toward normalizing beta band activities for improving speech and upper limb movement timing in PD.

Effects of rhythmic visual cues on cognitive resources allocation characterized by electroencephalographic (EEG) features during human gait initiation

Rhythmic visual cues are beneficial in gait initiation (GI) in Parkinson's disease patients with freezing of gait (FOG), however, the underlying neurophysiological mechanism remains poorly understood. The cognitive control modulated by visual cues during GI has been investigated and considered as a potential factor influencing automatic motor actions, but it is unclear how rhythmic visual cues affect cognitive resources demands during GI. The purpose of this study was to explore the effect of rhythmic visual cues on cognitive resources allocation by recording the anticipatory cerebral cortex electroencephalographic (EEG) activity during GI. Twenty healthy participants initiated gait in response to the rhythmic and non-rhythmic visual cues of stimulus presentation. We assessed the contingent negative variation (CNV) of averaged EEG data over 32 electrode positions during GI preparation, the results of which showed that the CNV was induced over prefrontal, frontal, central, and parietal regions in both rhythmic conditions and non-rhythmic conditions. Overall, different visual cues modulated the amplitude of CNV in the early and late stages of the GI preparation. Compared with the non-rhythmic condition, the CNV amplitude was lower in rhythmic condition over displayed regions precede the GI onset. In the late stage of GI preparation, it showed significant differences between the two conditions in prefrontal, frontal, and central regions, and the amplitude of CNV was lower under rhythmic condition. More to the point, the differences were more obvious in the late stage of GI preparation between the two conditions, which was closely associated with the cognitive resources. Therefore, the results indicate that less cognitive resources allocation is required to trigger GI under rhythmic visual cues compared with non-rhythmic visual cues. This study may provide a new insight into why rhythmic visual cues are more effective in improving GI ability compared to non-rhythmic visual cues.

Event-Related Potentials During Decision-Making in a Mixed-Strategy Game

The decisions we make are sometimes influenced by interactions with other agents. Previous studies have suggested that the prefrontal cortex plays an important role in decision-making and that the dopamine system underlies processes of motivation, motor preparation, and reinforcement learning. However, the physiological mechanisms underlying how the prefrontal cortex and the dopaminergic system are involved in decision-making remain largely unclear. The present study aimed to determine how decision strategies influence event-related potentials (ERPs). We also tested the effect of levodopa, a dopamine precursor, on decision-making and ERPs in a randomized double-blind placebo-controlled investigation. The subjects performed a matching-pennies task against an opposing virtual computer player by choosing between right and left targets while their ERPs were recorded. According to the rules of the matching-pennies task, the subject won the trial when they chose the same side as the opponent, and lost otherwise. We set three different task rules: (1) with the alternation (ALT) rule, the computer opponent made alternating choices of right and left in sequential trials; (2) with the random (RAND) rule, the opponent randomly chose between right and left; and (3) with the GAME rule, the opponent analyzed the subject's past choices to predict the subject's next choice, and then chose the opposite side. A sustained medial ERP became more negative toward the time of the subject's target choice. A biphasic potential appeared when the opponent's choice was revealed after the subject's response. The ERPs around the subject's choice were greater in RAND and GAME than in ALT, and the negative peak was enhanced by levodopa. In addition to these medial ERPs, we observed lateral frontal ERPs tuned to the choice direction. The signals emerged around the choice period selectively in RAND and GAME when levodopa was administered. These results suggest that decision processes are modulated by the dopamine system when a complex and strategic decision is required, which may reflect decision updating with dopaminergic prediction error signals.

Deep brain stimulation of subthalamic nucleus helps in improving late phase motor planning in Parkinson's disease

OBJECTIVE

Deep brain stimulation of subthalamic nucleus (DBS-STN) is a well-accepted treatment for Parkinson's disease (PD) but its effect on motor planning in the disease is yet unclear. This study examines the effect of switching the stimulation ON and OFF on components of bereitschaftspotentials in PD.

PATIENTS AND METHODS

Scalp bereitschaftspotentials were recorded during self-paced right wrist extensions at Fz, Cz, Pz, C3 and C4 sites in patients on DBS-STN plus medications (DBS-STN group) as treatment modality or on medications only (Med group) and compared with age matched healthy controls. In DBS-STN group, the potentials were recorded in stimulation ON, stimulation OFF, and again after re-switching stimulation ON-2. Offline analysis of potentials was done to calculate peak amplitude, late slope (-500 to 0ms) and early slope (-1500 to -500ms).

RESULTS

We observed that the two components of bereitschaftspotentials in stimulation ON state were comparable to those in age matched controls. The late slope was found to be significantly reduced during stimulation OFF as compared to stimulation ON at Cz (p<0.001), C3 (p<0.001) and C4 (p<0.01) electrode sites. This parameter failed to improve on re-switching stimulation ON at Cz (p<0.01). No significant change was observed in early part of bereitschaftspotentials among any of the conditions.

CONCLUSION

Our study shows that DBS-STN along with anti-parkinsonian medications helps in improving both components of bereitschaftspotentials in PD. Switching stimulation OFF for fifteen minutes principally affects the late component i.e. the execution part of motor planning; which cannot be reversed by re-switching ON. Thus the chronic and acute effects of switching DBS-STN ON are different and principally affect the later part of motor planning.

Motivational engagement in Parkinson's disease: Preparation for motivated action

The current study investigated whether motivational dysfunction in Parkinson's patients is related to a deficit in preparing for motivated behavior. Based on previous studies, it was hypothesized that PD patients would show reduced preparation for action specifically when faced with threat (of loss) and that reduced action preparation would relate to self-report of apathy symptoms. The study measured an electrocortical correlate of preparation for action (CNV amplitude) in PD patients and healthy controls, as well as defensive and appetitive activation during emotional perception (LPP amplitude). The sample included 18 non-demented PD patients (tested on dopaminergic medications) and 15 healthy controls who responded as quickly as possible to cues signaling threat of loss or reward, in which the speed of the response determined the outcome. Results indicated that, whereas PD patients showed similar enhanced action preparation with the addition of incentives to controls, PD patients showed generally reduced action preparation, evidenced by reduced CNV amplitude overall. Results suggest that PD patients may have behavioral issues due to globally impaired action preparation but that this deficit is not emotion-specific, and movement preparation may be aided by incentive in PD patients.

Effects of amplitude cueing on postural responses and preparatory cortical activity of people with Parkinson disease

BACKGROUND AND PURPOSE

Persons with Parkinson disease (PD) are unable to modify their postural responses, and show an associated increase in cortical preparatory activity for anticipated postural perturbations. In this study we asked whether participants with PD could modify their postural responses and cortical preparatory activity when cued to focus on increasing movement amplitude before a series of predictable postural perturbations.

METHODS

Twelve participants with PD performed postural responses to 30 identical backward surface translations. We cued participants to focus on increasing movement amplitude, and examined the effects of cueing by measuring postural responses (center-of-pressure initial rate of change, automatic postural response stability, peak trunk flexion, peak ankle extension) and preparatory cortical activity (electroencephalographic measures of contingent negative variation, alpha and beta event-related desynchronization).

RESULTS

Participants with PD modified their postural responses during the amplitude trials by increasing trunk flexion, slowing center-of-pressure initial rate of change, and decreasing automatic postural response stability. However, no significant differences in contingent negative variation amplitude or alpha or beta event-related desynchronization were observed with versus without amplitude cueing.

DISCUSSION AND CONCLUSIONS

Persons with PD were able to modify their feet-in-place postural responses with amplitude cueing. These changes were not associated with changes in cortical preparation during amplitude cue trials, suggesting that other regions or measures of brain function were responsible for changes in postural responses. Future studies are needed to determine the effects of long-term amplitude-cueing practice on cortical preparation and postural stability.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A78) for more insights from the authors.

Contingent negative variation is associated with cognitive dysfunction and secondary progressive disease course in multiple sclerosis

BACKGROUND AND PURPOSE

The relationship between contingent negative variation (CNV), which is an event-related potential, and cognition in multiple sclerosis (MS) has not been examined previously. The primary objective of the present study was thus to determine the association between CNV and cognition in a sample of MS patients.

METHODS

The subjects of this study comprised 66 MS patients [50 with relapsing-remitting MS (RRMS) and 16 with secondary progressive MS (SPMS)] and 40 matched healthy volunteers. A neuropsychological battery was administered to all of the subjects; CNV recordings were made from the Cz, Fz, and Pz electrodes, and the amplitude and area under the curve (AUC) were measured at each electrode.

RESULTS

RRMS patients exhibited CNVs with lower amplitudes and smaller AUCs than the controls at Pz. SPMS patients exhibited CNVs with lower amplitudes and smaller AUCs than the controls, and CNVs with a smaller amplitude than the RRMS patients at both Cz and Pz. After correcting for multiple comparisons, a lower CNV amplitude at Pz was significantly associated with worse performance on measures of speed of information processing, verbal fluency, verbal learning, and verbal recall.

CONCLUSIONS

CNV may serve as a marker for disease progression and cognitive dysfunction in MS. Further studies with larger samples and wider electrode coverage are required to fully assess the value of CNV in these areas.

Effects of magnitude and magnitude predictability of postural perturbations on preparatory cortical activity in older adults with and without Parkinson's disease

The goal of this study was to identify whether impaired cortical preparation may relate to impaired scaling of postural responses of people with Parkinson's disease (PD). We hypothesized that impaired scaling of postural responses in participants with PD would be associated with impaired set-dependent cortical activity in preparation for perturbations of predictable magnitudes. Participants performed postural responses to backward surface translations. We examined the effects of perturbation magnitude (predictable small vs. predictable large) and predictability of magnitude (predictable vs. unpredictable-in-magnitude) on postural responses (center-of-pressure (CoP) displacements) and on preparatory electroencephalographic (EEG) measures of contingent negative variation (CNV) and alpha and beta event-related desynchronization (ERD). Our results showed that unpredictability of perturbation magnitude, but not the magnitude of the perturbation itself, was associated with increased CNV amplitude at the CZ electrode in both groups. While control participants scaled their postural responses to the predicted magnitude of the perturbation, their condition-related changes in CoP displacements were not correlated with condition-related changes in EEG preparatory activity (CNV or ERD). In contrast, participants with PD did not scale their postural responses to the predicted magnitude of the perturbation, but they did demonstrate greater beta ERD in the condition of predictably small-magnitude perturbations and greater beta ERD than the control participants at the CZ electrode. In addition, increased beta ERD in PD was associated with decreased adaptability of postural responses, suggesting that preparatory cortical activity may have a more direct influence on postural response scaling for people with PD than for control participants.

Contingent negative variation as a dopaminergic biomarker: evidence from dose-related effects of methylphenidate

RATIONALE

The basal ganglia play an important role in motor control, which is dependent on dopaminergic input. Preparation of a motor response has been associated with dopamine release in the basal ganglia, and response readiness may therefore serve as a pharmacodynamic marker of dopamine activity.

METHODS

We measured response readiness using the amplitude of the contingent negative variation (CNV), a slow negative shift in the electroencephalogram. The CNV is evoked in a paradigm in which a warning stimulus (S1) signals the occurrence of the imperative stimulus (S2) 4 s later, to which the participant has to respond. CNV was assessed in healthy volunteers after administration of placebo or 10, 20 or 40 mg of methylphenidate, a catecholamine re-uptake blocker which primarily enhances the synaptic concentration of dopamine and to a lesser extent also noradrenaline. In addition, participants filled out two visual analogue scales measuring subjective ratings of mood and alertness: Profile of Mood States and Bond and Lader.

RESULTS

Methylphenidate dose dependently increased CNV amplitude and decreased reaction times. Furthermore, participants reported improved mood, feeling more alert, vigorous and content and less angry and tired after methylphenidate.

CONCLUSIONS

These results indicate that dopamine availability increases response readiness as measured by the CNV paradigm. The CNV appears to be a good candidate biomarker for assessing changes in dopaminergic function by treatments that either directly or indirectly target the dopaminergic system.

Involvement of the basal ganglia and cerebellar motor pathways in the preparation of self-initiated and externally triggered movements in humans

The subthalamic nucleus (STN) is part of the cortico-basal ganglia (BG)-thalamocortical circuit, whereas the ventral lateral nucleus of the thalamus (VL) is a relay nucleus in the cerebello-dentato-thalamocortical (CTC) pathway. Both pathways have been implicated in movement preparation. We compared the involvement of the STN and VL in movement preparation in humans by recording local field potentials (LFPs) from seven patients with Parkinson's disease with deep-brain stimulation (DBS) electrodes in the STN and five patients with tremor and electrodes in VL. LFPs were recorded from DBS electrodes and scalp electrodes simultaneously while the patients performed self-paced and externally cued (ready, go/no-go) movements. For the self-paced movement, a premovement-related potential was observed in all patients from scalp, STN (phase reversal, five of six patients), and VL (phase reversal, five of five patients) electrodes. The onset times of the potentials were similar in the cortex, STN, and VL, ranging from 1.5 to 2 s before electromyogram onset. For the externally cued movement, an expectancy potential was observed in all patients in cortical and STN electrodes (phase reversal, six of six patients). The expectancy potential was recorded from the thalamic electrodes in four of five patients. However, phase reversal occurred only in one case, and magnetic resonance imaging showed that this contact was outside the VL. The cortico-BG-thalamocortical circuit is involved in the preparation of both self-paced and externally cued movements. The CTC pathway is involved in the preparation of self-paced but not externally cued movements, although the pathway may still be involved in the execution of these movements.

Kinesthetic but not visual imagery assists in normalizing the CNV in Parkinson's disease

OBJECTIVE

This study investigated whether kinesthetic and/or visual imagery could alter the contingent negative variation (CNV) for patients with Parkinson's disease (PD).

METHODS

The CNV was recorded in six patients with PD and seven controls before and after a 10min block of imagery. There were two types of imagery employed: kinesthetic and visual, which were evaluated on separate days.

RESULTS

The global field power (GFP) of the late CNV did not change after the visual imagery for either group, nor was there a significant difference between the groups. In contrast, kinesthetic imagery resulted in significant group differences pre-, versus post-imagery GFPs, which was not present prior to performing the kinesthetic imagery task. In patients with PD, the CNV amplitudes post-, relative to pre-kinesthetic imagery, increased over the dorsolateral prefrontal regions and decreased in the ipsilateral parietal regions. There were no such changes in controls.

CONCLUSIONS

A 10-min session of kinesthetic imagery enhanced the GFP amplitude of the late CNV for patients but not for controls.

SIGNIFICANCE

While the study needs to be replicated with a greater number of participants, the results suggest that kinesthetic imagery may be a promising tool for investigations into motor changes, and may potentially be employed therapeutically, in patients with Parkinson's disease.

Two phases of the contingent negative variation in humans: Association with motor and mental functions

The question of the relationship between contingent negative variation and the mechanisms controlling motor and mental functions has received inadequate study. The aims of the present work were to investigate the relationship between the early and late phases of contingent negative variation and the state of motor and mental functions in patients with Parkinson's disease and to study the effects of levodopa on contingent negative variation. Patients with Parkinson's disease showed significant decreases in the amplitudes and areas of both phases of contingent negative variation as compared with subjects of similar age. Correlation analysis demonstrated a negative relationship between the extent of impairment of coordinatory muscle interactions and the amplitudes of both phases of this variation (p < 0.01). There was a positive relationship between the magnitudes of both phases and the state of mental functions, particularly memory (p < 0.05). Treatment of patients with Parkinson's disease with levodopa was followed by a significant increase in the late phase (p < 0.05). The results obtained here provide evidence for the important role of structures supporting both direct motor control and mental functions in forming both phases of contingent negative variation. The greater effect of levodopa on the late phase of contingent negative variation suggests that the efferent system of the basal ganglia has a greater role in generating the late phase than in organizing the early phase of the variation.

Performance monitoring and error processing during a lexical decision task in patients with Parkinson's disease

To evaluate performance monitoring and error processing during lexical decision tasks, event-related potentials (ERPs) obtained by time-locked to correct and error responses were studied in 17 Parkinson's disease (PD) patients without dementia and 15 healthy elderly participants. The amplitude of error negativity (Ne) obtained by averages time-locked to error response was significantly reduced in the PD patients, whereas there were no significant differences in the negative component for the correct response (Nc) between the two participant groups. The amplitude of the error positivity (Pe) and correct positivity (Pc) after the Ne and Nc components was also significantly reduced in the PD patients. The PD patients showed significantly slower reaction times and higher error rates. The reduced amplitude of the Ne, Pe, and Pc components in the PD patients suggested impaired performance and conflict monitoring as well as abnormal response strategy adjustments and deviant in later error monitoring processes associated with emotional, conscious evaluation of the error.

Contingent negative variation elicited before jaw and tongue movements

Contingent negative variation (CNV) is a negative brain potential occurring between two successive stimuli when the first stimulus is a warning and the second stimulus requires a motor response. The CNV is interpreted as an expression of the cognitive processes in preparation for a response directed to a purpose. Using 19 electrodes we recorded CNVs for mouth opening, closing and lateral movements, tongue protrusion and hand extension in 10 healthy subjects. The aim of the study was to examine the motor control mechanism underlying jaw and tongue movements in a cognitive paradigm. The first stimulus (S1) served as a preparatory warning signal for the imperative stimulus (S2) 2 s after the S1. The subject performed the experimental tasks after the S2. The grand average CNVs for jaw and tongue movements showed a bilaterally widespread negativity with the maximum in the vertex region (Cz). The early CNV was identified about 400 ms after the S1 and its amplitude was highest at the midline-frontal area. The late CNV started approximately 1000 ms after the S1 with the maximum at Cz. The mean amplitude was significantly lower for hand extension than for the other tasks, and significantly higher for lateral movement than for mouth closing, suggesting that the CNV amplitude can be affected by the complexity of the task. The CNV recording may provide a means to study the neuronal activity necessary for the sensorimotor integration of jaw and tongue movements.

Maintenance of response readiness in patients with Parkinson's disease: evidence from a simple reaction time task

The authors explored the effect of Parkinson's disease (PD) on the generation and maintenance of response readiness in a simple reaction time task. They compared performance of idiopathic PD patients without dementia, age-matched controls, and younger controls over short (1-, 3-, and 6-s) and long (12- and 18-s) foreperiod intervals. After each trial, the authors probed memory for visual information that also had to be maintained during the trial interval. Patients and controls did not differ overall in their ability to maintain readiness over long delays. However, within the PD group only, errors in maintaining visual information were correlated with difficulty in maintaining readiness, suggesting that systems impaired in PD may facilitate the maintenance of processing in both motor and cognitive domains.

Motor cortex dysfunction revealed by cortical excitability studies in Parkinson's disease: influence of antiparkinsonian treatment and cortical stimulation

Single or paired pulse paradigms of transcranial magnetic stimulation (TMS) provide several parameters to test motor cortex excitability, such as motor threshold (MT), motor evoked potential (MEP) amplitude, electromyographic silent period to cortical stimulation (CSP) and intracortical facilitation (ICF) or inhibition (ICI). Various changes in TMS parameters, revealing motor cortex dysfunction, were found in patients with Parkinson's disease (PD). For instance, low MT and increased MEP size disclosed an enhanced corticospinal motor output at rest, while reduced ICF and failure of MEP size increase during contraction suggested defective facilitatory cortical inputs, particularly for movement execution. Inhibitory cortical pathways were also found less excitable at rest (reduced ICI) and sometimes during contraction (shortened CSP). By restoring cortical inhibition, dopaminergic drugs and deep brain stimulation probably overcome the difficulty to focus neuronal activity onto the appropriate network required for a specific motor task. The application of repetitive TMS trains over motor cortical areas also showed some effect on cortical excitability, opening perspectives to consider the motor cortex as a target for therapeutic neuromodulation in PD. However, systematic studies of cortical excitability remained to be performed in large series of patients with PD, taking into account disease stage, clinical symptoms and medication influence.

Malfunctions of Central Control of Movement Studied with Slow Brain Potentials in Neurological Patients

Abstract Studies are reviewed that used movement-related EEG potentials to investigate impairments of movement control in neurological patients. The EEG potentials reviewed are the Bereitschaftspotential (BP), Contingent Negative Variation (CNV), and components of the lateralized readiness potential (LRP). Patient groups included in this review are patients with infarction of the middle cerebral artery, Parkinson's disease, cerebellar disease, and amyotrophic lateral sclerosis. A rich body of evidence has been collected on Parkinson's disease, and somewhat less on cerebellar atrophy, contributing to an understanding of the impairments caused by these diseases. In contrast, not much research has been done in amyotrophic lateral sclerosis and in infarction patients. The latter is particularly striking since utility of this method for assessing residual capacities of affected motor areas seems rather obvious.

Event-related potentials in the frontal cortex, hippocampus, and cerebellum during a temporal discrimination task in rats

The purpose of this study was to evaluate the roles of the frontal cortex, hippocampus, and cerebellum in timing and time perception using event-related potentials (ERPs) in rats. Rats were trained to discriminate between 2-s and 8-s auditory signal durations using a choice procedure. A simple reaction-time task using only the 2-s signal served as the control condition. In both tasks, ERPs were computed at stimulus onset and offset. Auditory ERPs were recorded from the frontal cortex, hippocampus, and cerebellum. The stimulus onset ERPs consisted of P2, N2, and P3-like components. Significantly greater amplitudes of the P3-like components were observed during the temporal-discrimination task when compared to the simple reaction-time task. At the stimulus offset, P2, N2, and P3-like components were elicited as well as the stimulus onset. Only in the frontal cortex was the P3-like component that appeared at the stimulus offset larger for the temporal-discrimination task than for the simple reaction-time task. These results suggest that the frontal cortex, hippocampus, and cerebellum contribute to interval timing in the seconds range.

Early contingent negative variation (CNV) shows a small symmetrical negativity in a somatosensory paradigm

The influence of sensory modulation on the early stage of information processing was investigated with a somatosensory contingent negative variation (CNV) paradigm. Whether or not even a somatosensory input as well as auditory or visual stimulus to one hemisphere elicits the symmetrical "early CNV" was also examined. Eleven normal individuals (3 males, 8 females) performed a conventional CNV paradigm with a click sound as the warning stimulus (WS) and a red light flash as the imperative stimulus (IS). Nine individuals (5 males, 4 females) did the somatosensory CNV paradigm with paired electrical stimuli as WS and IS. The subjects were instructed to press a button in response to IS as fast as possible. The early CNV amplitude was smaller and P300 latency was longer in somatosensory paradigm than conventional paradigm. In addition, the latency of P100 in a somatosensory paradigm was longer than that of N100 in a conventional paradigm. These findings suggest that the initiation of early detection, reflected by P100, the initiation of cognition, reflected by P300, and orienting response, reflected by early CNV, are delayed in a somatosensory CNV paradigm. Furthermore, all event-related potentials (ERPs) evoked by somatosensory stimuli showed a bilateral symmetry.

Basal ganglia involvement in sensory and cognitive processing. A depth electrode CNV study in human subjects

OBJECTIVE

Intracranial recordings were taken from the basal ganglia (BG) in order to explore the possible role of the BG in the cognitive processing of sensory information.

METHODS

Ten patients with intractable temporal lobe epilepsy, who were candidates for epilepsy surgery, underwent intracranial recordings with depth electrodes. A frontal approach was used for the insertion of diagonal depth electrodes into the amygdalo-hippocampal complex (AH complex). These electrodes passed through the BG. The putamen was explored in 8 patients; the nucleus caudatus and pallidum were explored in two patients. The contingent negative variation (CNV) paradigm was tested using auditory warning stimuli and visual imperative stimuli followed by a hand flexion. The auditory and visual middle and late latency potentials evoked by the warning and imperative stimuli were analyzed.

RESULTS

(1) Auditory evoked potentials (EPs): the amplitude potential gradient was observed with latencies of (a) 150-195ms (9 patients); (b) 215-290ms (9 patients); and (c) 350-600ms (10 patients). Negative potentials, with latencies of 100 and 110ms were observed in two patients. (2) Visual EPs: (a) 160-195ms (9 patients); (b) 210-295ms (9 patients); and (c) 330-550ms (7 patients). Negative potentials with latencies between 100 and 120ms were observed in 4 patients. CNV was obtained from the BG in 8 patients; a phase reversal was observed twice.

CONCLUSIONS

(1) The BG generate middle and late latency EPs in a cognitive paradigm linked to the motor task. (2) The BG generate CNV. (3) The BG could play an integrative role in the processing of sensory, cognitive, and motor information.

Bereitschaftspotential in depressed and non-depressed patients with Parkinson's disease

Impaired initiation and slowed execution of movements are two of the principal characteristics of Parkinson's disease (PD). A similar pattern of movement impairments (psychomotor retardation) can be seen frequently in patients with idiopathic depression. In addition, affective disorders have been frequently reported in patients with different basal ganglia disorders. The aim of this study was to determine whether there are some particularities in the cerebral electrical activity during the preparation and execution of voluntary internally paced movements (i.e., Bereitschaftspotential, BP) in depressed PD patients, which can distinguish them from non-depressed PD patients, as well as from healthy controls. The BPs were recorded in 16 patients with idiopathic PD, eight of whom were depressed (PD-D), and eight of whom were not (PD-ND). Additional recordings were taken from a group of eight age- and sex-matched healthy subjects. Depression was classified using the Research Diagnostic Criteria and the two PD groups were matched for age, disease severity, and disease duration. The amplitudes and slopes of the BPs from PD patients were generally smaller than in controls, but there was no specific pattern of BP changes that distinguished depressed from non-depressed PD patients. In addition, there was no particular association between measures of depression severity and BP parameters. The data suggest that presence of depression in PD might not have any additional deteriorating influence on already impaired preparation for self-paced spontaneous movements.

High resolution spatiotemporal analysis of the contingent negative variation in simple or complex motor tasks and a non-motor task

OBJECTIVES

Since the characteristics of the Bereitschaftspotential (BP) - voluntary movement paradigm of internally-driven movements - have been established recently by our group using high resolution DC-EEG techniques, it was of great interest to apply similar techniques to the other slow brain potential--contingent negative variation (CNV) of externally-cued movements--with the same motor tasks using the same subjects.

METHODS

The CNV for simple bimanual sequential movements (task 1), complex bimanual sequential movements (task 2) and a non-motor condition (task 3) was recorded on the scalp using a 64 channel DC-EEG in 16 healthy subjects, and the data were analyzed with high resolution spatiotemporal statistics and current source density (CSD).

RESULTS

(1) The CNV was distributed over frontal, frontocentral, central and centroparietal regions; a negative potential was found at the frontal pole and a positive potential was found over occipital regions. (2) CNV amplitudes were higher for task 2 than for task 1, and there was no late CNV for task 3. (3) A high resolution spatiotemporal analysis revealed that during the early CNV component, statistical differences existed between the motor tasks (tasks 1 and 2) and the non-motor task (task 3), which occurred at frontocentral, central, centroparietal, parietal and parieto-occipital regions. During the late CNV component, additional significant differences were found not only between the motor tasks and the non-motor task but also between motor task 1 and task 2 at frontocentral, central and centroparietal regions. (4) Comparison of the CNV between the frontomesial cortex (situated over the supplementary/cingulate areas, SCMA) and both lateral pre-central areas (situated over the primary motor areas, MIs) showed that there was no statistically significant difference between the two cortical motor areas except for the early CNV. (5) Comparison of the CNV between the 3 tasks over the cortical motor areas showed that there were significant differences between the motor tasks and the non-motor task regarding the auditory evoked potential (AEP) and the early CNV component, and between all 3 tasks in the late CNV, the visual evoked potential (VEP(2)) and the N-P component. (6) The ranges and the densities of the CSD maps were larger and higher for complex than for simple tasks. The current sinks of the AEP and the early CNV were located at Fz, the late CNV at FCz and surrounding regions. As to be expected, current sources of the VEPs were located at the occipital lobes. The CNV was a current sink (negative) except for the VEP's main component which was a current source (positive).

CONCLUSIONS

(1) The CNV topography over the scalp varied with the complexity of motor tasks and between motor and non-motor conditions. (2) The origin of the early CNV may rest in the frontal lobes, while the late CNV may stem from more extensive cortical areas including SCMA, MIs, etc. (3) The late CNV component is not identical with the BP.

Reduced activation of midline frontal areas in human elderly subjects: a contingent negative variation study

Contingent negative variation (CNV) was recorded from electrodes F7, F3, Fz, F4, F8, T7, C3, Cz, C4, T8, P7, P3, Pz, P4 and P8 in 19 young (mean age: 23 years) and 15 elderly (mean age: 66 years) healthy right-handed subjects, using a S2-choice paradigm. Young subjects showed early peak negativity shortly after the warning stimulus over mid-frontal areas, whereas for the remaining electrodes the negativity increased continuously. The amplitude of the early CNV was selectively reduced in elderly subjects over midline but not lateral frontal areas. We conclude that the activation of frontal midline areas as pre-supplementary motor area or anterior cingulate might be impaired in higher age.

Bilateral subthalamic nucleus stimulation improves frontal cortex function in Parkinson's disease. An electrophysiological study of the contingent negative variation

Parkinson's disease involves impaired activation of frontal cortical areas, including the supplementary motor area and prefrontal cortex, resulting from impaired thalamocortical output of the basal ganglia. Electrophysiologically, such impaired cortical activation may be seen as a reduced amplitude of the contingent negative variation (CNV), a slow negative potential shift reflecting cognitive processes associated with the preparation and/or anticipation of a response. Surgical interventions aimed at increasing basal ganglia-thalamic outflow to the cortex, such as electrical stimulation of the subthalamic nucleus with chronically implanted electrodes, have been shown to be effective in improving the clinical symptoms of Parkinson's disease. This study examined changes in cortical activity, as reflected in the CNV, associated with bilateral subthalamic nucleus stimulation in Parkinson's disease. The CNV was recorded from 10 patients with Parkinson's disease when on and off bilateral subthalamic nucleus stimulation, and was compared with the CNV of 10 healthy control subjects. Without subthalamic nucleus stimulation, Parkinson's disease patients showed reduced CNV amplitudes over the frontal and frontocentral regions compared with control subjects. With bilateral subthalamic nucleus stimulation, however, CNV amplitudes over the frontal and frontocentral regions were significantly increased. Results therefore suggest that impaired cortical functioning in Parkinson's disease, particularly within the frontal and premotor areas, is improved by subthalamic nucleus stimulation.

Sensory-motor transformation and motor planning in the primate frontal cortex

To examine the role of the frontal cortex in sensory-motor processing, we trained a Rhesus monkey to perform a behavioral task with alternations between localization (LOC) and non-localization (NL) paradigms. In the LOC block, the monkey had to remember the modality and location of two sequential cues. Two different GO signals instructed the monkey to touch the memorized location of either auditory or visual spatial cues (GO-AUD or GO-VIS, respectively). In the NL paradigm the monkey received the same stimuli, but was instructed to touch a fixed target, disregarding the location and modality of the spatial and GO signals. Reaction time was significantly longer after GO-AUD signals in the LOC mode compared to the reaction time following GO-VIS signals, or in the NL mode. We examined 961 neurons in the frontal cortex and 427 parietal neurons. A group of frontal task-related neurons (72/430; 16.7%) showed evoked activity both after the visual and the GO-AUD stimuli in the LOC mode. The units did not respond to the GO-VIS signal that instructed the monkey to move to the same location, or to the identical stimuli in the NL mode. No such neurons were found in the sampled areas of the parietal cortex. Our findings suggest that the monkey initially planned a default response towards the location of the visual stimulus and immediately updated his motor plans when instructed to touch the memorized location of the auditory stimulus. We suggest that frontal activity may also be related to such modifications of sensory-motor associations.

Intersubject variability and intrasubject reproducibility of the bereitschaftspotential

We assessed the intersubject variability and intrasubject reproducibility of the bereitschaftspotential (BP). Twenty healthy volunteers performed extensions of their wrist in a self-paced manner every 5-10 seconds. A surface electromyography (EMG) electrode was attached to the wrist extensor group of the dominant hand to record at least 100 wrist movements, and electroencephalography electrodes were placed over the scalp. Trials were performed at baseline, 15 minutes, 4 hours, and 4 weeks. Measures derived from the BP included area 1 (-2000 to -650 msec), area 2 (-650-0 msec), total area (area 1 + area 2), amplitude at -650 msec, amplitude at peak negativity prior to EMG onset, and amplitude at 0 msec (trigger). Our findings revealed different variability/reproducibility depending on the particular BP measure being analyzed. Using intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) as measures of intrasubject reproducibility, area 2, amplitude at peak negativity prior to EMG onset, and amplitude at 0 msec produced the best values. We conclude that in studies that attempt to quantify BP changes before and after an intervention in the same group of subjects, the most reproducible BP measures are those pertaining to the late BP component.

Correlation between contingent negative variation and regional cerebral blood flow

The relationship between contingent negative variation (CNV) and regional cerebral blood flow was investigated, using the stable xenon computed tomography method. Seventeen cases of chronic multiple cerebral infarction in the perforating artery areas (vascular dementia, mean age 67.0), 6 cases of Alzheimer's disease (mean age 69.5) and 8 healthy controls (mean age 62.5) were studied. Regional cerebral blood flows in the frontal, temporal, parietal and occipital cortex, frontal, temporal and occipital white matter, caudate nucleus, putamen and thalamus were measured. The amplitude of early CNV was significantly smaller in the vascular dementia group than in the healthy control group. The blood flows in the parietal cortex and thalamus were significantly lower in the vascular dementia group than in the healthy control group. There was a significant positive correlation between the amplitude of early CNV and frontal cortex blood flow. No significant correlations were present between the CNV and the other regional cerebral blood flows nor in healthy controls. The amplitude of CNV has been reported to be decreased in dementia. From the present study, the amplitude of early CNV was considered to be influenced by the blood flow in the frontal cortex.

Cortical mechanism underlying externally cued gait initiation studied by contingent negative variation

In order to clarify the cortical mechanism underlying gait initiation, we examined the scalp distribution of the contingent negative variation (CNV) preceding externally cued gait initiation in a simple reaction-time paradigm in 10 healthy right-handed men, and compared the results with the CNV preceding simple foot dorsiflexion. A pair of auditory stimuli was given with an interstimulus (S1-S2) interval of 2 s and gait consisting of at least 3 steps was initiated with the right footstep as fast as possible in response to S2. Brisk dorsiflexion of the right foot was employed as a control task. It was found that the late CNV in the gait initiation task started about 1 s before S2, and was largest at Cz (-9.3 +/- 3.1 microV) without clear asymmetry over the scalp. However, it was ill defined in the parietal area. In the foot dorsiflexion task, the late CNV was maximal at Cz (-7.1 +/- 2.9 microV), and clearly seen also over the parietal area. The late CNV at Cz was significantly (P < 0.01) larger in the gait initiation than in the simple foot dorsiflexion. The amplitude of the late CNV preceding the foot dorsiflexion task was not significantly different between the sitting and the standing posture. In view of the results of previous invasive studies in both humans and animals which showed some frontal areas, including the supplementary motor area (SMA) and the primary motor cortex, as the generators of the late CNV, it is suggested that the cerebral cortex is active in initiation of externally triggered gait in a different way from the simple foot movement, and that bilateral SMAs may play a more important role in gait initiation than in simple foot movement.